S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   6934
 
                        2023-2024 Regular Sessions
 
                           I N  A S S E M B L Y
 
                                May 9, 2023
                                ___________
 
 Introduced  by M. of A. GUNTHER -- read once and referred to the Commit-
   tee on Higher Education
 
 AN ACT to amend the mental hygiene law, in  relation  to  the  scope  of
   practice of psychiatric nurse practitioners
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:

   Section 1. Subdivision 48 of section 1.03 of the mental  hygiene  law,
 as  added  by  chapter  223  of the laws of 1992, is amended and two new
 subdivisions 13 and 14 are added to read as follows:
   13. "NURSE PRACTITIONER" MEANS A NURSE PRACTITIONER CERTIFIED PURSUANT
 TO SECTION SIXTY-NINE HUNDRED TEN OF THE EDUCATION LAW, PRACTICING WITH-
 IN HIS OR HER SCOPE OF PRACTICE.
   14. "PSYCHIATRIC NURSE PRACTITIONER" MEANS A NURSE PRACTITIONER CERTI-
 FIED BY THE DEPARTMENT OF EDUCATION AS A PSYCHIATRIC NURSE PRACTITIONER.
   48.  "Practitioner"  shall  mean  a  physician,  NURSE   PRACTITIONER,
 dentist,  podiatrist,  veterinarian,  scientific  investigator, or other
 person licensed, or otherwise  permitted  to  dispense,  administer,  or
 conduct research with respect to a controlled substance in the course of
 a  licensed  professional practice or research licensed pursuant to this
 article.  Such person shall be deemed a "practitioner" only as  to  such
 substances,  or  conduct relating to such substances, as is permitted by
 his license, permit, or otherwise permitted by law.
   § 2. Section 9.01 of the mental hygiene law, as amended by chapter 723
 of the laws of 1989 and the 7th undesignated  paragraph  as  amended  by
 chapter 595 of the laws of 2000, is amended to read as follows:
 § 9.01 Definitions.
   As used in this article:
   (A)  "in  need of care and treatment" means that a person has a mental
 illness for which in-patient care and treatment in a hospital is  appro-
 priate.
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD10908-01-3
 A. 6934                             2
              

 
   (B)  "in  need  of involuntary care and treatment" means that a person
 has a mental illness for which care and treatment  as  a  patient  in  a
 hospital  is essential to such person's welfare and whose judgment is so
 impaired that he is unable to understand the  need  for  such  care  and
 treatment.
   (C)  "likelihood  to  result  in serious harm" or "likely to result in
 serious harm" means [(a)]:
   1. a substantial risk of physical harm to the person as manifested  by
 threats  of  or  attempts  at  suicide  or  serious bodily harm or other
 conduct demonstrating  that  the  person  is  dangerous  to  himself  or
 herself[,]; or
   [(b)] 2. a substantial risk of physical harm to other persons as mani-
 fested by homicidal or other violent behavior by which others are placed
 in reasonable fear of serious physical harm.
   (D)  "need for retention" means that a person who has been admitted to
 a hospital pursuant to this article is in need of involuntary  care  and
 treatment in a hospital for a further period.
   (E)  "record"  of  a  patient  shall consist of admission, transfer or
 retention papers and orders, and  accompanying  data  required  by  this
 article and by the regulations of the commissioner.
   (F)  "director  of community services" means the director of community
 services for the mentally disabled appointed pursuant to article  forty-
 one of this chapter.
   (G)  "qualified  psychiatrist"  means a physician licensed to practice
 medicine in New York state who:
   [(a)] 1. is a diplomate  of  the  American  board  of  psychiatry  and
 neurology or is eligible to be certified by that board; or
   [(b)]  2.  is certified by the American osteopathic board of neurology
 and psychiatry or is eligible to be certified by that board.
   (H) "QUALIFIED PSYCHIATRIC NURSE  PRACTITIONER"  MEANS  A  PSYCHIATRIC
 NURSE  PRACTITIONER WHO HAS RECEIVED A RELEVANT BOARD CERTIFICATION FROM
 A NATIONAL ACCREDITING BODY OR IS  ELIGIBLE  TO  BE  CERTIFIED  BY  SUCH
 BOARD.
   §  3. Section 9.05 of the mental hygiene law, as renumbered by chapter
 978 of the laws of 1977, is amended to read as follows:
 § 9.05 Examining physicians OR NURSE PRACTITIONERS and  medical  certif-
          icates.
   (a)  A person is disqualified from acting as an examining physician OR
 NURSE PRACTITIONER in the following cases:
   1. if he OR SHE is a relative of the person applying for the admission
 or of the person alleged to be mentally ill.
   2. if he OR SHE is a manager, trustee, visitor,  proprietor,  officer,
 director,  or stockholder of the hospital in which the patient is hospi-
 talized or to which it is proposed  to  admit  such  person,  except  as
 otherwise provided in this chapter, or if he has any pecuniary interest,
 directly or indirectly, in such hospital, provided that receipt of fees,
 privileges,  or  compensation for treating or examining patients in such
 hospital shall not be deemed to be a pecuniary interest.
   3. if he OR SHE is on the staff of a proprietary facility to which  it
 is proposed to admit such person.
   (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 EXAMINING physicians OR NURSE PRACTITION-
 A. 6934                             3
 
 ERS is based and shall show that the condition of the person examined is
 such that he needs involuntary care and treatment in a hospital and such
 other information as the commissioner may by regulation require.
   §  4.  Subdivision  (a), paragraph 11 of subdivision (b), and subdivi-
 sions (d), (e) and (i) of section 9.27 of the mental hygiene law, subdi-
 visions (a), (d) and (e) as renumbered by chapter 978  of  the  laws  of
 1977,  paragraph  11  of  subdivision (b) as added by chapter 343 of the
 laws of 1985, and subdivision (i) as amended by chapter 847 of the  laws
 of 1987, 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 certificates of  two  examining  physicians,
 NURSE  PRACTITIONERS, OR A COMBINATION THEREOF, accompanied by an appli-
 cation for  the  admission  of  such  person.  The  examination  may  be
 conducted jointly but each examining physician AND/OR NURSE PRACTITIONER
 shall execute a separate certificate.
   11.  a qualified psychiatrist OR PSYCHIATRIC NURSE PRACTITIONER who is
 either supervising the treatment of or treating such person for a mental
 illness in a facility licensed or  operated  by  the  office  of  mental
 health.
   (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, NURSE PRACTITIONER,  or
 psychologist  furnishing 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 OR NURSE PRAC-
 TITIONER who shall be a member of the psychiatric staff of such hospital
 other than the original examining physicians AND/OR NURSE  PRACTITIONERS
 whose  certificate  or  certificates accompanied the application and, if
 such person is found to be in need of involuntary care and treatment, he
 OR SHE may be admitted thereto as a patient as herein provided.
   (i) After an application for  the  admission  of  a  person  has  been
 completed  and  [both]  THE  physicians  AND/OR NURSE PRACTITIONERS have
 examined such person and separately certified that he or she is mentally
 ill and in need of involuntary care and treatment in a hospital,  either
 physician OR NURSE PRACTITIONER is authorized to request peace officers,
 when  acting  pursuant  to their special duties, or police officers, who
 are members of an authorized police department or force or  of  a  sher-
 iff'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
 physician  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 such person to a hospital for determination
 by the director whether such person qualifies for admission pursuant  to
 this section.
   §  5.  Subdivisions  (a) and (c) of section 9.37 of the mental hygiene
 law, subdivision (a) as amended by chapter 723 of the laws of 1989,  and
 A. 6934                             4
 
 subdivision  (c)  as  amended  by  chapter  230 of the laws of 2004, are
 amended to read as follows:
   (a)  The  director  of  a  hospital, upon application by a director of
 community services or an examining physician OR NURSE PRACTITIONER  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 director'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.
   (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 OR NURSE PRACTITIONER may apply
 for  the  admission  of  a  patient  pursuant  to this section without a
 medical examination by a designated physician OR NURSE PRACTITIONER,  if
 a hospital approved by the commissioner pursuant 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 OR NURSE PRACTITIONER 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 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 admitted, the need for hospital-
 ization  shall  be confirmed by another staff physician OR NURSE PRACTI-
 TIONER within twenty-four hours. An application pursuant to this  subdi-
 vision  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  state-
 ment in a form prescribed by the commissioner giving such information as
 he  OR  SHE  may  deem appropriate, including a statement of the efforts
 A. 6934                             5
 
 made by the director of community services to locate a designated  exam-
 ining  physician  OR  NURSE  PRACTITIONER prior to making an application
 pursuant to this subdivision.
   §  6.  Subdivision  (a)  of section 9.37 of the mental hygiene law, as
 amended by chapter 251 of the laws  of  1972,  is  amended  to  read  as
 follows:
   (a)  The  director  of  a  hospital, upon application by a director of
 community services or an examining physician OR NURSE PRACTITIONER  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  immedi-
 ate  inpatient care and treatment in a hospital is appropriate and which
 is likely to result in serious harm to himself  or  HERSELF  OR  others;
 "likelihood of serious harm" shall mean:
   1.  substantial  risk  of physical harm to himself OR HERSELF as mani-
 fested by threats of or attempts at suicide or serious  bodily  harm  or
 other conduct demonstrating that he OR SHE is dangerous to himself[,] OR
 HERSELF; 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] OF 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.
   § 7. Subdivision (a) of section 9.39 of the  mental  hygiene  law,  as
 amended  by  chapter  789  of  the  laws  of 1985, is amended to read as
 follows:
   (a) The director of any hospital maintaining adequate staff and facil-
 ities for the observation, examination, care, and treatment  of  persons
 alleged  to  be mentally ill and approved by the commissioner to receive
 and retain patients pursuant to this  section  may  receive  and  retain
 therein  as a patient for a period of fifteen days any person alleged to
 have a mental illness for which immediate observation, care, and  treat-
 ment in a hospital is appropriate and which is likely to result in seri-
 ous harm to himself or HERSELF OR others. "Likelihood to result in seri-
 ous harm" as used in this article shall mean:
   1.  substantial  risk  of physical harm to himself OR HERSELF as mani-
 fested by threats of or attempts at suicide or serious  bodily  harm  or
 other conduct demonstrating that he OR SHE is dangerous to himself[,] OR
 HERSELF; or
 A. 6934                             6
 
   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 of serious physical harm.
   The  director  shall cause to be entered upon the hospital records the
 name of the person or persons, if any, who have brought such  person  to
 the  hospital and the details of the circumstances leading to the hospi-
 talization of such person.
   The director shall admit such person pursuant  to  the  provisions  of
 this section only if a staff physician OR PSYCHIATRIC NURSE PRACTITIONER
 of  the  hospital upon examination of such person finds that such person
 qualifies under the requirements of this section. Such person shall  not
 be  retained  for  a period of more than forty-eight hours unless within
 such period such finding  is  confirmed  after  examination  by  another
 physician OR PSYCHIATRIC NURSE PRACTITIONER who shall be a member of the
 psychiatric  staff  of the hospital. Such person shall be served, at the
 time of admission, with written notice of his OR HER status  and  rights
 as a patient under this section. Such notice shall contain the patient's
 name.  At  the  same time, such notice shall also be given to the mental
 hygiene legal service and personally  or  by  mail  to  such  person  or
 persons,  not to exceed three in number, as may be designated in writing
 to receive such notice by the person alleged to be mentally ill.  If  at
 any  time  after  admission,  the  patient, any relative, friend, or the
 mental hygiene legal service gives notice to the director in writing  of
 request for court hearing on the question of need for immediate observa-
 tion, care, and treatment, a hearing shall be held as herein provided as
 soon  as practicable but in any event not more than five days after such
 request is received, except that the commencement of such hearing may be
 adjourned at the request of the patient. It shall be  the  duty  of  the
 director  upon  receiving  notice of such request for hearing to forward
 forthwith a copy of such notice with a record  of  the  patient  to  the
 supreme  court  or  county  court  in  the county where such hospital is
 located. A copy of such notice and record shall also  be  given  TO  the
 mental hygiene legal service. The court which receives such notice shall
 fix  the  date  of  such  hearing  and cause the patient or other person
 requesting the hearing, the director, the mental hygiene  legal  service
 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 examine the person
 alleged to be mentally ill, if it be  deemed  advisable  in  or  out  of
 court,  and  shall render a decision in writing that there is reasonable
 cause to believe that the patient has a mental illness for which immedi-
 ate 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
 it be determined that there is such reasonable cause,  the  court  shall
 forthwith  issue  an order authorizing the retention of such patient for
 any such purpose or purposes in the hospital for a period not to  exceed
 fifteen  days  from the date of admission. Any such order entered by the
 court shall not be deemed to be an  adjudication  that  the  patient  is
 mentally ill, but only a determination that there is reasonable cause to
 retain the patient for the purposes of this section.
   §  8.  Subdivisions  (b) and (c) of section 9.40 of the mental hygiene
 law, subdivision (b) as amended by section 2 of part PPP of  chapter  58
 of  the laws of 2020, and subdivision (c) 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   not
 discharged  after  the  provision  of triage and referral services to be
 A. 6934                             7
 
 initiated by a staff physician OR PSYCHIATRIC NURSE PRACTITIONER of  the
 program  as  soon as practicable and in any event within 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 exam-
 ination for up to twenty-four hours if, at the conclusion of such  exam-
 ination,  such  physician  OR  PSYCHIATRIC NURSE PRACTITIONER determines
 that such person may have a mental illness for which immediate  observa-
 tion,  care,  and  treatment  in  a  comprehensive psychiatric emergency
 program is appropriate, 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  examining  staff  physician OR PSYCHIATRIC NURSE
 PRACTITIONER has been confirmed after examination by  another  physician
 OR  PSYCHIATRIC  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 chap-
 ter. 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  observation, care and treatment shall be made, and
 court hearings shall be scheduled  and  held,  in  the  manner  provided
 pursuant  to  subdivision  (a) of section 9.39 of this article, provided
 however, if a person is removed or 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.
   § 9. Paragraph 2 of subdivision (d) of  section  9.51  of  the  mental
 hygiene  law,  as  amended by section 1 of part NNN of chapter 58 of the
 laws of 2020, is amended to read as follows:
   (2)  Proper  treatment  of  the  individual's  psychiatric   condition
 requires  in-patient  care and treatment under the direction of a physi-
 cian OR PSYCHIATRIC NURSE PRACTITIONER; and
   § 10. Section 9.55 of the mental hygiene law, as  amended  by  chapter
 598 of the laws of 1994, is amended to read as follows:
 § 9.55 Emergency  admissions for immediate observation, care, and treat-
            ment; powers of qualified psychiatrists AND PSYCHIATRIC NURSE
            PRACTITIONERS.
   A qualified psychiatrist OR QUALIFIED PSYCHIATRIC  NURSE  PRACTITIONER
 shall  have  the power to direct the removal of any person, whose treat-
 ment for a mental illness he or she is either supervising  or  providing
 in  a facility licensed or operated by the office of mental health which
 does not have an inpatient psychiatric service, to a  hospital  approved
 by  the commissioner pursuant to subdivision (a) of section 9.39 of this
 article or to a 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. Upon the request  of  such
 qualified  psychiatrist  OR  QUALIFIED  PSYCHIATRIC  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
 A. 6934                             8
 
 of a sheriff's department shall take into custody and transport any such
 person.  Upon  the  request  of  a  qualified  psychiatrist OR QUALIFIED
 PSYCHIATRIC 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 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.
   § 11. Section 9.55 of the mental hygiene law, as  amended  by  chapter
 847 of the laws of 1987, is amended to read as follows:
 § 9.55 Emergency  admissions for immediate observation, care, and treat-
            ment; powers of qualified psychiatrists AND QUALIFIED PSYCHI-
            ATRIC NURSE PRACTITIONERS.
   A qualified psychiatrist OR QUALIFIED PSYCHIATRIC  NURSE  PRACTITIONER
 shall  have  the power to direct the removal of any person, whose treat-
 ment for a mental illness he OR SHE is either supervising  or  providing
 in  a facility licensed or operated by the office of mental health which
 does not have an inpatient psychiatric service, to a  hospital  approved
 by  the commissioner pursuant to subdivision (a) of section 9.39 of this
 article, if he OR SHE determines upon examination of  such  person  that
 such  person appears to have a mental illness for which immediate obser-
 vation, 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 9.39 of this article. Upon the request of such quali-
 fied psychiatrist OR QUALIFIED  PSYCHIATRIC  NURSE  PRACTITIONER,  peace
 officers,  when acting pursuant to their special duties, or police offi-
 cers, 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  QUALIFIED
 PSYCHIATRIC  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 in accordance with the provisions of section 9.39 of this arti-
 cle.
   § 12. Section 9.57 of the mental hygiene law, as  amended  by  chapter
 598 of the laws of 1994, is amended to read as follows:
 § 9.57 Emergency  admissions  for immediate observation, care and treat-
            ment; powers of emergency  room  physicians  AND  PSYCHIATRIC
            NURSE PRACTITIONERS.
   A  physician  OR  PSYCHIATRIC  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 PSYCHIATRIC NURSE PRACTITIONER who has examined a person in
 a  comprehensive  psychiatric  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 pursuant to subdivision (a) of  section  9.39  of  this
 article  or  to  a  comprehensive  psychiatric emergency program, if the
 physician OR PSYCHIATRIC 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 HERSELF OR
 others. Upon the request of the physician OR PSYCHIATRIC  NURSE  PRACTI-
 TIONER,  the  director  of  the  program  or hospital, or the director's
 designee, is authorized to direct peace officers, when  acting  pursuant
 A. 6934                             9
 
 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  OR  PSYCHIATRIC  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 thou-
 sand 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 arti-
 cle or to a comprehensive psychiatric emergency  program  in  accordance
 with the provisions of section 9.40 of this article.
   §  13.  Section  9.57 of the mental hygiene law, as amended by chapter
 847 of the laws of 1987, is amended to read as follows:
 § 9.57 Emergency admissions for immediate observation, care  and  treat-
            ment;  powers  of  emergency  room physicians AND PSYCHIATRIC
            NURSE PRACTITIONERS.
   A physician OR PSYCHIATRIC  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 authorized to request that the director of the hospital,  or  his  OR
 HER  designee,  direct the removal of such person to a hospital approved
 by the commissioner pursuant to subdivision (a) of section 9.39 of  this
 article,  if  the physician OR PSYCHIATRIC 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
 HERSELF  OR others, as defined in section 9.39 of this article. Upon the
 request of the physician OR PSYCHIATRIC NURSE PRACTITIONER, the director
 of the hospital, or his OR HER designee, is authorized to  direct  peace
 officers,  when acting pursuant to their special duties, or police offi-
 cers, 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  OR  PSYCHIATRIC
 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
 TO A HOSPITAL in accordance with the provisions of section 9.39 of  this
 article.
   §  14.  Paragraph  2  of subdivision (d) of section 9.58 of the mental
 hygiene law, as amended by chapter 230 of the laws of 2004,  is  amended
 to read as follows:
   (2)   "Qualified  mental  health  professional"  shall mean a licensed
 psychologist, registered professional nurse,  licensed  clinical  social
 worker  or  a  licensed  master social worker under the supervision of a
 physician, PSYCHIATRIC NURSE  PRACTITIONER,  psychologist,  or  licensed
 clinical social worker.
   §  15.  Subparagraph (iii) of paragraph 4 of subdivision (c), subpara-
 graph (v) of paragraph 1 and paragraphs 3  and  4  of  subdivision  (e),
 paragraphs  1, 2, 3 and 4 of subdivision (h), subdivision (i), paragraph
 2 of subdivision (k), and subdivision (n) of section 9.60 of the  mental
 hygiene  law,  subparagraph  (iii) of paragraph 4 of subdivision (c) and
 paragraph 2 of subdivision (h) as amended by section 2 of subpart  H  of
 part UU of chapter 56 of the laws of 2022, subparagraph (v) of paragraph
 1  and paragraph 3 of subdivision (e), paragraphs 1, 3 and 4 of subdivi-
 A. 6934                            10
 
 sion (h), and subdivision (i) as amended by chapter 158 of the  laws  of
 2005,  paragraph  4  of subdivision (e) as amended by chapter 382 of the
 laws of 2015, and paragraph 2 of subdivision (k) and subdivision (n)  as
 amended  by  chapter  1  of  the  laws  of  2013, are amended to read as
 follows:
   (iii) notwithstanding subparagraphs (i) and (ii)  of  this  paragraph,
 resulted in the issuance of a court order for assisted outpatient treat-
 ment which has expired within the last six months, and since the expira-
 tion  of the order, the person has experienced a substantial increase in
 symptoms of mental illness and such  symptoms  substantially  interferes
 with  or  limits  one  or  more major life activities as determined by a
 director of community services who previously was required to coordinate
 and monitor the care of any individual who was subject to  such  expired
 assisted outpatient treatment order. The applicable director of communi-
 ty  services  or  their  designee shall arrange for the individual to be
 evaluated by a physician  OR  PSYCHIATRIC  NURSE  PRACTITIONER.  If  the
 physician  OR  PSYCHIATRIC  NURSE  PRACTITIONER determines court ordered
 services are clinically necessary and the least restrictive option,  the
 director of community services may initiate a court proceeding[.]; AND
   (v)  a  qualified  psychiatrist OR QUALIFIED PSYCHIATRIC NURSE PRACTI-
 TIONER 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 PSYCHIATRIC NURSE PRACTITIONER, who shall not  be  the
 petitioner, stating either that:
   (i)  such  physician  OR PSYCHIATRIC 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  PSYCHIATRIC NURSE PRACTITIONER or his or her designee has
 made appropriate attempts but has not been successful in  eliciting  the
 cooperation  of the subject of the petition to submit to an examination,
 such physician OR PSYCHIATRIC NURSE PRACTITIONER has reason  to  suspect
 that  the subject of the petition meets the criteria for assisted outpa-
 tient treatment, and such physician OR PSYCHIATRIC 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 eighty thousand, the
 affirmation or affidavit required by paragraph three of this subdivision
 may be made by a physician OR PSYCHIATRIC 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 PSYCHIATRIC NURSE  PRAC-
 TITIONER  for  the  purpose  of  making  such  affirmation  or affidavit
 consistent with the provisions of such paragraph.
   (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  PSYCHIATRIC 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 PSYCHIATRIC NURSE PRACTITIONER whose affirma-
 A. 6934                            11

 tion or affidavit 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 appropriate 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 PSYCHIATRIC 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,
 testifies in person or by video  conference  at  the  hearing.  Provided
 however,  a  physician  OR  PSYCHIATRIC NURSE PRACTITIONER shall only be
 authorized to testify by video conference when it has  been:  (i)  shown
 that  diligent  efforts  have been made to attend such hearing in person
 and the subject of the petition consents to the physician OR PSYCHIATRIC
 NURSE PRACTITIONER testifying by video conference;  or  (ii)  the  court
 orders  the  physician  OR  PSYCHIATRIC NURSE PRACTITIONER to testify by
 video conference upon a finding of good cause. Such physician OR PSYCHI-
 ATRIC NURSE PRACTITIONER shall state the  facts  and  clinical  determi-
 nations  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  PSYCHIATRIC NURSE PRACTITIONER, the court may request the
 subject to consent to an examination by a physician OR PSYCHIATRIC 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 offi-
 cers, acting pursuant to their special duties, or  police  officers  who
 are  members  of an authorized police department or force, or of a sher-
 iff's department to take the subject of the petition  into  custody  and
 transport  him  or  her  to a hospital for examination by a physician OR
 PSYCHIATRIC NURSE PRACTITIONER. 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 PSYCHI-
 ATRIC  NURSE PRACTITIONER whose affirmation or affidavit accompanied the
 petition pursuant to paragraph three of subdivision (e) of this section,
 if such physician OR PSYCHIATRIC 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 PSYCHIATRIC NURSE PRAC-
 TITIONER,  the examining physician OR PSYCHIATRIC NURSE PRACTITIONER may
 consult with the  physician  OR  PSYCHIATRIC  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 PSYCHIATRIC NURSE PRACTITIONER who testifies pursu-
 ant to paragraph 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 outpa-
 tient  treatment.  If  the  recommended  assisted  outpatient  treatment
 includes  medication,  such physician's OR PSYCHIATRIC NURSE PRACTITION-
 ER'S testimony shall describe the types or classes of  medication  which
 A. 6934                            12
 
 should  be  authorized,  shall  describe  the beneficial and detrimental
 physical and mental effects of  such  medication,  and  shall  recommend
 whether  such  medication should be self-administered or administered by
 authorized personnel.
   (i)  Written  treatment  plan.  (1) The court shall not order assisted
 outpatient treatment unless a physician OR PSYCHIATRIC NURSE PRACTITION-
 ER appointed by the appropriate  director,  in  consultation  with  such
 director,  develops  and provides to the court a proposed written treat-
 ment plan. The written treatment  plan  shall  include  case  management
 services  or assertive community treatment team services to provide care
 coordination. The written treatment plan also shall include all  catego-
 ries  of  services,  as set forth in paragraph one of subdivision (a) of
 this section, which such physician  OR  PSYCHIATRIC  NURSE  PRACTITIONER
 recommends that the subject of the petition receive. All service provid-
 ers 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 medica-
 tion  most  likely  to  provide  maximum 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  physi-
 cian's OR PSYCHIATRIC NURSE PRACTITIONER'S clinical basis for recommend-
 ing  such  plan provides sufficient facts for the court to find (i) that
 such person has a history of alcohol or substance abuse  that  is  clin-
 ically  related  to  the  mental  illness; and (ii) that such testing is
 necessary to prevent a relapse or deterioration 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  PSYCHIATRIC  NURSE  PRACTITIONER  appointed  to
 develop  the  written treatment plan shall provide the following persons
 with an opportunity to actively participate in the development  of  such
 plan: the subject of the petition; the treating physician OR PSYCHIATRIC
 NURSE  PRACTITIONER,  if any; and upon the request of the subject of the
 petition, an individual significant to the subject including  any  rela-
 tive, 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 PSYCHIATRIC 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 PSYCHIATRIC NURSE PRACTITIONER appearing  on  behalf  of  a
 director  testifies to explain the written proposed treatment plan. Such
 physician OR PSYCHIATRIC 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 medication, such physician OR PSYCHIATRIC  NURSE
 PRACTITIONER shall state the types or classes of medication recommended,
 the beneficial and detrimental physical and mental effects of such medi-
 cation,  and  whether  such  medication  should  be self-administered or
 administered by an authorized professional. If the subject of the  peti-
 A. 6934                            13

 tion  has  executed  a  health care proxy, such physician OR PSYCHIATRIC
 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 direc-
 tor is the petitioner, such testimony shall be given on the date set  by
 the  court  pursuant  to  paragraph  three  of  subdivision  (j) of this
 section.
   (2) Within thirty days prior to the expiration of an order of assisted
 outpatient treatment, the appropriate director or the current  petition-
 er,  if  the  current petition 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 para-
 graph 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  PSYCHI-
 ATRIC  NURSE  PRACTITIONER  who  developed the written treatment plan or
 another physician OR PSYCHIATRIC NURSE PRACTITIONER  designated  by  the
 director,  and such physician OR PSYCHIATRIC 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 PSYCHIATRIC NURSE PRACTITIONER, (i)
 the assisted outpatient[,] has failed or  refused  to  comply  with  the
 assisted outpatient treatment, (ii) efforts were made to solicit compli-
 ance,  and  (iii) such assisted outpatient may be in need of involuntary
 admission to a hospital 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 PSYCHIATRIC  NURSE  PRACTITIONER
 may  request  the appropriate director of community services, the direc-
 tor's designee, or  any  physician  OR  PSYCHIATRIC  NURSE  PRACTITIONER
 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 PSYCHIATRIC NURSE PRACTITIONER may consider such refusal or
 failure  when  determining whether the assisted outpatient is in need of
 an examination to determine whether he or she has a mental  illness  for
 which  hospitalization  is necessary. Upon the request of such physician
 OR PSYCHIATRIC NURSE PRACTITIONER, the appropriate director, the  direc-
 tor's  designee,  or  any  physician  OR  PSYCHIATRIC NURSE PRACTITIONER
 designated pursuant to section 9.37 of this article,  may  direct  peace
 A. 6934                            14

 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 operating the assisted outpatient
 treatment program or to any  hospital  authorized  by  the  director  of
 community  services  to receive such persons. Such law enforcement offi-
 cials shall carry out such directive. Upon the request of such physician
 OR PSYCHIATRIC NURSE PRACTITIONER, the appropriate director, the  direc-
 tor's  designee,  or  any  physician  OR  PSYCHIATRIC 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  author-
 ized  by  the appropriate director of community services to receive such
 persons. Any director of community services, or THE DIRECTOR'S 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 accord-
 ance 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 observation, care, and treatment and  further  exam-
 ination  in  the hospital for up to seventy-two hours to permit a physi-
 cian OR PSYCHIATRIC 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 arti-
 cle,  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 involun-
 tary civil commitment or a finding of contempt of court.
   §  16.  Subdivisions  (d),  (e) and (f) of section 33.04 of the mental
 hygiene law, subdivisions (d) and (f) as added by  chapter  779  of  the
 laws of 1977, and subdivisions (d) and (f) as renumbered and subdivision
 (e)  as  amended by chapter 334 of the laws of 1980, are amended to read
 as follows:
   (d) Restraint shall be [effected] AFFECTED only by written order of  a
 physician OR PSYCHIATRIC NURSE PRACTITIONER after a personal examination
 of the patient except in an emergency situation, as provided by subdivi-
 sion (e) of this section. The order shall set forth the facts justifying
 the  restraint  and  shall  specify  the nature of the restraint and any
 conditions for maintaining the restraint. The order shall also set forth
 the time of expiration of the authorization, with such  order  to  apply
 for  a  period  of  no more than four hours, provided, however, that any
 such order imposing restraint after nine o'clock p.m. may  extend  until
 nine  o'clock a.m. of the next day.  A full record of restraint, includ-
 ing all signed orders of physicians OR PSYCHIATRIC NURSE  PRACTITIONERS,
 shall  be  kept in the patient's file and shall be subject to inspection
 by authorized persons.
   (e) If an emergency situation exists in which the patient is  engaging
 in  activity  that presents an immediate danger to himself or HERSELF OR
 A. 6934                            15
 
 others and a physician is not immediately available,  restraint  may  be
 [effected]  AFFECTED only to the extent necessary to prevent the patient
 from injuring himself or HERSELF OR  others  at  the  direction  of  the
 senior  member  of  the  staff who is present.   The senior staff member
 shall cause a physician OR PSYCHIATRIC NURSE PRACTITIONER  to  be  imme-
 diately  summoned  and  shall record the time of the call and the person
 contacted.   Pending the arrival of a  physician  OR  PSYCHIATRIC  NURSE
 PRACTITIONER, the patient shall be kept under constant supervision. If a
 physician OR PSYCHIATRIC NURSE PRACTITIONER does not arrive within thir-
 ty  minutes  of being summoned, the senior staff member shall record any
 such delay in the patient's clinical record  and  also  place  into  the
 patient's  clinical record a written description of the facts justifying
 the emergency restraint which shall specify the nature of the  restraint
 and  any conditions for maintaining the restraint until the arrival of a
 physician OR  PSYCHIATRIC  NURSE  PRACTITIONER,  the  reasons  why  less
 restrictive  forms  of restraint were not used, and a description of the
 steps taken to assure that the patient's needs, comfort, and safety were
 properly cared for. Such physician  OR  PSYCHIATRIC  NURSE  PRACTITIONER
 shall place in the clinical record an explanation for any such delay.
   (f) During the time that a patient is in restraint, he OR SHE shall be
 monitored to see that his OR HER physical needs, comfort, and safety are
 properly  cared  for.  An assessment of the patient's condition shall be
 made at least once every thirty minutes or at more frequent intervals as
 directed by a physician OR PSYCHIATRIC NURSE PRACTITIONER.  The  assess-
 ment  shall  be  recorded and placed in the patient's file. A patient in
 restraint shall be released from restraint at  least  every  two  hours,
 except  when  asleep.  If at any time a patient upon being released from
 restraint makes no overt gestures that would threaten  serious  harm  or
 injury to himself or HERSELF OR others, restraint shall not be reimposed
 and  a  physician OR PSYCHIATRIC NURSE PRACTITIONER shall be immediately
 notified. Restraint shall not be reimposed in such situation unless,  in
 the  physician's  OR PSYCHIATRIC NURSE PRACTITIONER'S professional judg-
 ment, release would be harmful to the patient or others.
   § 17. This act shall take effect immediately; provided, however,  that
 the amendments to:
   a.  subdivision  (a) of section 9.37 of the mental hygiene law made by
 section five of this act shall be subject to the expiration  and  rever-
 sion  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
 six of this act shall take effect;
   b.  subdivisions (b) and (c) of section 9.40 of the mental hygiene law
 made by section eight of this act shall not affect the  repeal  of  such
 section and shall be deemed repealed therewith;
   c.  section 9.55 of the mental hygiene law made by section ten of this
 act shall be subject to the expiration and  reversion  of  such  section
 pursuant  to  section 21 of chapter 723 of the laws of 1989, as amended,
 when upon such date the provisions of section eleven of this  act  shall
 take effect;
   d.  section  9.57  of the mental hygiene law made by section twelve of
 this act shall be subject  to  the  expiration  and  reversion  of  such
 section  pursuant  to  section 21 of chapter 723 of the laws of 1989, as
 amended, when upon such date the provisions of section thirteen of  this
 act shall take effect; and
   e.  subparagraph (iii) of paragraph 4 of subdivision (c), subparagraph
 (v) of paragraph 1 and paragraphs 3 and 4 of subdivision (e), paragraphs
 1, 2, 3 and 4 of subdivision (h), subdivision (i), paragraph 2 of subdi-
 A. 6934                            16
 
 vision (k), and subdivision (n) of section 9.60 of  the  mental  hygiene
 law  made  by section fifteen of this act shall not affect the repeal of
 such section and shall be deemed repealed therewith.