Bellevue Assisted Outpatient Treatment Legislation
In 1995, the NYS Legislature passed a bill authorizing a one year trial of an Assisted Outpatient Treatment Program at Bellevue Hospital in New York City. Due to a slow start-up, the legislature later extended it to two years. The bill expires in the Summer of 1999 and before then NYC is charged with deciding whether or not to propose expanding the program to the rest of the state, and if so, with what modifications. Any proposal NY makes (due to be announced March 1, 1999) will have to be passed by the legislature. Following is the initial legislation authorizing the pilot. You can jump to the bill introduced 3/1/1999 by Elizabeth Connelly to extend this bill statewide.
* § 9.61 Involuntary outpatient treatment.
(a) Involuntary outpatient treatment. For the purposes of this section, “involuntary outpatient treatment” shall include the following categories of services which have been ordered by the court: medication; individual or group therapy; day or partial day programming activities; services and training, including educational and vocational activities; supervision of living arrangement; intensive case management services under the auspices of a program funded by the office of mental health; and any other services within the local plan developed pursuant to arti-cle forty-one of this chapter, prescribed to treat the person’s mental illness and to assist the person in living and functioning in the commu-nity, or to attempt to prevent a relapse or deterioration that may reasonably be predicted to result in the need for hospitalization. (b) Pilot project. The director of community services, in conjunction with the president of the New York city health and hospitals corpo-ration, shall establish by July first, nineteen hundred ninety-five, within amounts made available therefor, an involuntary outpatient treat-ment pilot program. Such program shall serve those patients who can benefit from involuntary outpatient treatment and who have been hospi-talized at a hospital operated by such corporation, designated by the president of such corporation in consultation with the director of community services of such city. All patients admitted to such hospital pursuant to this article shall be eligible. The involuntary outpatient treatment program, including intensive case management services, shall be carried out under the direction and supervision of such hospital. With the approval of the appropriate state agency, priority shall be given to patients in the pilot treatment program by the office of mental health, the department of health and the department of social services with regard to access to residential facilities under the control of such agencies. The president of the New York city health and hospitals corporation in consultation with the state office of mental health shall issue guidelines pertaining to the manner and place for the adminis-tration of medication under subdivision (k) of this section. (c) Criteria for involuntary outpatient treatment. (1) A patient may be ordered to obtain involuntary outpatient treatment if the court finds that:
(i) the patient is eighteen years of age or older; and (ii) the patient is suffering from a mental illness; and (iii) the patient is incapable of surviving safely in the community without supervision, based on a clinical determination; and (iv) the patient is hospitalized at the hospital designated pursuant to subdivision (b) of this section to take part in the pilot project, or in the case of an application for an additional period of treatment, the patient is currently receiving involuntary outpatient treatment; and (v) the patient has a history of lack of compliance with treatment that has necessitated involuntary hospitalization at least twice within the last eighteen months; and (vi) the patient is, as a result of his or her mental illness, unlike-ly to voluntarily participate in the recommended treatment pursuant to the treatment plan; and (vii) in view of the patient’s treatment history and current behavior, the patient is in need of involuntary outpatient treatment in order to prevent a relapse or deterioration which would be likely to result in serious harm to the patient or others as defined in section 9.01 of this article; and (viii) it is likely that the patient will benefit from involuntary outpatient treatment; and (ix) the involuntary outpatient treatment program of such hospital is willing and able to provide the involuntary outpatient treatment ordered.
(2) A court may order the involuntary administration of psychotropic drugs as part of an involuntary outpatient treatment program if the court finds the hospital has shown by clear and convincing evidence that the patient lacks the capacity to make a treatment decision as a result of mental illness and the proposed treatment is narrowly tailored to give substantive effect to the patient’s liberty interest in refusing medication, taking into consideration all relevant circumstances, including the patient’s best interest, the benefits to be gained from the treatment, the adverse side effects associated with the treatment and any less intrusive alternative treatments. Such order shall specify the type and amount of such psychotropic drugs and the duration of such involuntary administration.
(d) Application to the court. (1) An application to obtain an order authorizing involuntary outpatient treatment may be initiated only by the director of the hospital in which the patient is hospitalized. The director shall make such application to the supreme court in the county where the hospital is located.
(2) The application shall state:
(i) each of the criteria for involuntary outpatient treatment as set forth in subdivision (c) of this section;
(ii) facts which support such director’s belief that the patient who is the subject of the application meets such criteria, provided that the hearing on the application need not be limited to the stated facts; and (iii) a proposed written treatment plan for outpatient treatment for such patient. In causing such plan to be prepared, the director shall take steps to assure the following persons are interviewed and provided an opportunity to actively participate in the development of such plan: the patient; and upon the request of the patient, a significant individ-ual to the patient including any relative, close friend or individual otherwise concerned with the welfare of the patient. (3) The application shall be accompanied by an affirmation or affida-vit of an examining physician who has examined the patient who is the subject of the application no more than ten days prior to the submission of the application. Such affirmation or affidavit shall be attached to the application.
(e) Service. The director shall cause written notice of such applica-tion to be given to the patient and a copy thereof shall be given personally or by mail to the persons required by section 9.29 of this article to be served with notice of an involuntary patient’s initial admission and to the mental hygiene legal service. (f) Hearing. (1) Upon receipt by the court of the application by the director of the hospital submitted pursuant to subdivision (d) of this section, the court shall fix the date for a hearing at a time not later than five days from the date such application is received by the court, excluding Saturdays, Sundays and holidays. The court shall cause the patient, any other person receiving notice pursuant to subdivision (e) of this section, 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 patient alleged to be in need of involuntary outpatient treatment, if it be deemed advisable, in or out of court.
(2) No patient shall be ordered to receive involuntary outpatient treatment unless an examining physician who has personally examined the subject within the time period commencing ten days before the filing of the application and ending at the time of the physician’s testimony testifies in person at the hearing. Such physician’s testimony shall state the facts which support the allegation that the patient meets all the criteria for involuntary outpatient treatment, and the treatment is the least restrictive alternative, the recommended involuntary outpa-tient treatment, and the rationale for the recommended involuntary outpatient treatment. If the recommended involuntary outpatient treat-ment includes medication, such physician’s testimony shall describe the types or classes of medication which should be authorized, describe the beneficial and detrimental physical and mental effects of such medica-tion, and state that there is no less restrictive alternative treatment appropriate for the patient.
(g) Disposition. (1) If after hearing all relevant evidence, the court finds that the patient does not meet the criteria for involuntary outpa-tient treatment, the court shall dismiss the application. (2) If after hearing all relevant evidence, the court finds by clear and convincing evidence that the patient meets the criteria for involun-tary outpatient treatment, and there is no appropriate and feasible less restrictive alternative, the court shall be authorized to order such patient to receive involuntary outpatient treatment for a period not to exceed one hundred eighty days. In fashioning the order, the court shall specifically make findings by clear and convincing evidence that the proposed treatment is the least restrictive treatment appropriate and feasible for the patient. The order shall state the categories of invol-untary outpatient treatment, as set forth in subdivision (a) of this section, which the patient is to receive, and the court may not order treatment that has not been recommended by the examining physician and included in the written treatment plan for outpatient commitment as required by subparagraph (iii) of paragraph two of subdivision (d) of this section. The hospital operating the involuntary outpatient treat-ment program shall apply to the court for approval before instituting a proposed material change in the involuntary outpatient treatment order. Non-material changes may be instituted by the involuntary outpatient treatment program without court approval. For the purposes of this subdivision, a material change shall mean an addition or deletion of a category of involuntary outpatient treatment from the order of the court, or any deviation without the patient’s consent from the terms of an existing order relating to the involuntary administration of psycho-tropic drugs, or the proposed initiation of an order for the involuntary administration of psychotropic drugs.
(h) Applications for additional periods of treatment. If the director of such hospital determines that the condition of such patient requires further involuntary outpatient treatment, the director shall apply prior to the expiration of the period of involuntary outpatient treatment ordered by the court for an order authorizing continued involuntary outpatient treatment for a period not to exceed one hundred eighty days from the date of the order. The procedures for obtaining any order pursuant to this subdivision shall be in accordance with the provisions of the foregoing subdivisions of this section. The period for further involuntary outpatient treatment authorized by any subsequent order under this subdivision shall not exceed one hundred eighty days from the date of the order. Provided, further, any order authorizing involuntary outpatient treatment shall expire on June thirtieth, nineteen hundred ninety-nine, unless otherwise provided by law.
(i) Application for an order to stay, vacate or modify. In addition to any other right or remedy available by law with respect to the order for outpatient commitment, the patient, mental hygiene legal service, or anyone acting on the patient’s behalf may apply on notice to the direc-tor of the hospital to the court to stay, vacate or modify the order authorizing involuntary administration of psychotropic drugs. (j) Appeals. Review of an order issued pursuant to this section shall be had in like manner as specified in section 9.35 of this article.
(k) Failure to comply with involuntary outpatient treatment. (1) Where in the examining physician’s clinical judgment, the patient has failed or has refused to comply with the treatment ordered by the court, and in the examining physician’s clinical judgment, efforts were made to solic-it compliance, and, in the clinical judgment of such physician, such patient has a mental illness for which immediate observation, care and treatment in a hospital may be necessary pursuant to section 9.39 or 9.40 of this article, such physician may request the director of such hospital, or the director’s designee, to direct the removal of such patient to such hospital for an examination to determine if such person has a mental illness for which immediate observation, care and treatment in a hospital is necessary pursuant to section 9.39 or 9.40 of this article. Upon the request of such physician, the director of such hospi-tal or the director’s designee may 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. Such law enforcement officials shall carry out such directive. Upon the request of such physician, the director of such 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, shall be authorized to take into custody and transport any such person. Such person may then be evaluated for retention in accordance with the provisions of section 9.39 or 9.40 of this article as appropriate. Failure to comply with an order of involuntary outpatient commitment shall not be grounds for involuntary civil commitment or a finding of contempt of court. (2) While the order for outpatient commitment is in effect, and if in the examining physician’s clinical judgment the patient has failed or has refused to take such medication as the patient may be required to take pursuant to the order and in the examining physician’s clinical judgment, efforts were made to solicit compliance, the patient may be medicated over his or her objection by such examining physician. Such medication shall be administered in a manner and place that, in the best judgment of the physician administering such medication and consistent with the standards of the medical community in which he or she prac-tices, is clinically appropriate, safe, consistent with the dignity and privacy of the patient, and is in accordance with the guidelines issued pursuant to subdivision (b) of this section.
(l) Effect of determination that a person is in need of involuntary outpatient treatment. The determination by a court that a patient is in need of involuntary outpatient treatment under this section shall not be construed as or deemed to be a determination that such patient is impaired, incompetent or incapacitated pursuant to article seventy-sev-en, seventy-eight or eighty-one of this chapter as appropriate.
(m) Exception. Nothing in this section shall be construed to affect the ability of the director of a hospital to receive, admit, or retain patients who otherwise meet the provisions of this article regarding receipt, retention or admission. (Posted 2/1999)
* NB Expires 99/06/30
(end)
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Elizabeth Connelly introduced the following bill in the Assembly on 3/1/1999. It takes the provisions above and allows the Commissioner of Mental Health to establish the program statewide. It is the postion of the NY Treatment Advocacy Coalition, that many improvements should be made to the Bellevue Program:
Text of New York State Bill A05721
S T A T E O F N E W Y O R K
5721
1999-2000 Regular Sessions
I N A S S E M B L Y
March 1, 1999
___________
Introduced by M. of A. CONNELLY -- read once and referred to the Commit-
tee on Mental Health, Mental Retardation and Developmental Disabili-
ties
AN ACT to amend the mental hygiene law and chapter 560 of the laws of
1994, amending the judiciary law and the mental hygiene law relating
to establishing a pilot program of involuntary outpatient treatment,
in relation to making such program permanent and statewide
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
1 Section 1. Subdivision (b) of section 9.61 of the mental hygiene law,
2 as added by chapter 560 of the laws of 1994, is amended to read as
3 follows:
4 (b) Pilot project. (1) The director of community services, in conjunc-
5 tion with the president of the New York city health and hospitals corpo-
6 ration, shall establish by July first, nineteen hundred ninety-five,
7 within amounts made available therefor, an involuntary outpatient treat-
8 ment pilot program. Such program shall serve those patients who can
9 benefit from involuntary outpatient treatment and who have been hospi-
10 talized at a hospital operated by such corporation, designated by the
11 president of such corporation in consultation with the director of
12 community services of such city. All patients admitted to such hospital
13 pursuant to this article shall be eligible. The involuntary outpatient
14 treatment program, including intensive case management services, shall
15 be carried out under the direction and supervision of such hospital.
16 With the approval of the appropriate state agency, priority shall be
17 given to patients in the pilot treatment program by the office of mental
18 health, the department of health and the department of social services
19 with regard to access to residential facilities under the control of
20 such agencies. The president of the New York city health and hospitals
21 corporation in consultation with the state office of mental health shall
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
{ } is old law to be omitted.
LBD09049-01-9
A. 5721 2
1 issue guidelines pertaining to the manner and place for the adminis-
2 tration of medication under subdivision (k) of this section.
3 (2) THE COMMISSIONER OF MENTAL HEALTH, SHALL ESTABLISH BY JULY FIRST,
4 TWO THOUSAND, WITHIN AMOUNTS MADE AVAILABLE THEREFOR, AN INVOLUNTARY
5 OUTPATIENT TREATMENT PILOT PROGRAM. SUCH PROGRAM SHALL SERVE THOSE
6 PATIENTS WHO CAN BENEFIT FROM INVOLUNTARY OUTPATIENT TREATMENT AND WHO
7 HAVE BEEN HOSPITALIZED AT ANY HOSPITAL DESIGNATED BY SUCH COMMISSIONER
8 AS BEING ELIGIBLE FOR SUCH PROGRAM. ALL PATIENTS ADMITTED TO SUCH ELIGI-
9 BLE HOSPITAL PURSUANT TO THIS ARTICLE SHALL BE ELIGIBLE. THE INVOLUN-
10 TARY OUTPATIENT TREATMENT PROGRAM, INCLUDING INTENSIVE CASE MANAGEMENT
11 SERVICES, SHALL BE CARRIED OUT UNDER THE DIRECTION AND SUPERVISION OF
12 SUCH ELIGIBLE HOSPITAL. WITH THE APPROVAL OF THE APPROPRIATE STATE AGEN-
13 CY, PRIORITY SHALL BE GIVEN TO PATIENTS IN THE PILOT TREATMENT PROGRAM
14 BY THE OFFICE OF MENTAL HEALTH AND THE DEPARTMENT OF HEALTH WITH REGARD
15 TO ACCESS TO RESIDENTIAL FACILITIES UNDER THE CONTROL OF SUCH AGENCIES.
16 THE STATE OFFICE OF MENTAL HEALTH SHALL ISSUE GUIDELINES PERTAINING TO
17 THE MANNER AND PLACE FOR THE ADMINISTRATION OF MEDICATION UNDER SUBDIVI-
18 SION (K) OF THIS SECTION.
19 S 2. Subdivision (h) of section 9.61 of the mental hygiene law, as
20 amended by chapter 84 of the laws of 1998, is amended to read as
21 follows:
22 (h) Applications for additional periods of treatment. If the director
23 of such hospital determines that the condition of such patient requires
24 further involuntary outpatient treatment, the director shall apply prior
25 to the expiration of the period of involuntary outpatient treatment
26 ordered by the court for an order authorizing continued involuntary
27 outpatient treatment for a period not to exceed one hundred eighty days
28 from the date of the order. The procedures for obtaining any order
29 pursuant to this subdivision shall be in accordance with the provisions
30 of the foregoing subdivisions of this section. The period for further
31 involuntary outpatient treatment authorized by any subsequent order
32 under this subdivision shall not exceed one hundred eighty days from the
33 date of the order. {Provided, further, any order authorizing involuntary
34 outpatient treatment shall expire on June thirtieth, nineteen hundred
35 ninety-nine, unless otherwise provided by law.}
36 S 3. Section 6 of chapter 560 of the laws of 1994, amending the judi-
37 ciary law and the mental hygiene law relating to establishing a pilot
38 program of involuntary outpatient treatment, as amended by chapter 104
39 of the laws of 1997, is amended to read as follows:
40 S 6. This act shall take effect immediately {and shall expire June 30,
41 1999 when upon such date the provisions of this act shall be deemed
42 repealed}.
43 S 4. This act shall take effect immediately.
.SO DOC A 5721 *END* BTXT 1999
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