2006 New York Code - Discharge And Conditional Release Of Patients To The Community.

 
  § 29.15 Discharge and conditional release of patients to the community.
    (a)  A  patient  may  be  discharged  or conditionally released to the
  community by the director of a department facility, if, in  the  opinion
  of staff familiar with the patient's case history, such patient does not
  require active in-patient care and treatment.
    (b)  A  patient may be conditionally released, rather than discharged,
  when in the opinion of staff familiar with the patient's  case  history,
  the  clinical  needs  of  such  patient  warrant  this  more restrictive
  placement, provided, however, that
    1. an involuntary patient may be conditionally released only  for  the
  remainder of the authorized retention period; and
    2.  except as provided in subdivision (d) of this section, a voluntary
  patient may be conditionally released only for a  twelve  month  period,
  provided however that (i) a voluntary patient under sixteen years of age
  may  be  conditionally released only after consultation with the parent,
  legal guardian, or next-of-kin of such patient; (ii) a voluntary patient
  over sixteen and under  eighteen  years  of  age  may  be  conditionally
  released  only with his consent or with the consent of the parent, legal
  guardian, or next-of-kin of such  patient;  (iii)  a  voluntary  patient
  eighteen  years  of age or older may be conditionally released only with
  his consent.
    (c) The director of a department facility from which  any  patient  is
  conditionally released shall cause all such patients to be informed once
  during  each  one  hundred  twenty  days of conditional release of their
  status and rights, including their right  to  avail  themselves  of  the
  facilities  of  the  mental  hygiene  legal service. At the time of such
  periodic notification, the written consent of a patient to his continued
  stay on conditional release status shall be obtained and a copy  thereof
  shall be given to the mental hygiene legal service.
    (d)  1. No voluntary patient who has been conditionally released shall
  be continued on such status for a period beyond twelve months  from  the
  date  of  commencement  of  such status or beyond twelve months from the
  effective  date  of  this  statute,  whichever  is  later,  unless   the
  suitability of such patient to remain on such status and his willingness
  to  so  remain  have  been  reviewed.  The  director  shall  review  the
  suitability of such patient to remain in such  status,  and  the  mental
  hygiene  legal  service  shall review the willingness of such patient to
  remain in such status. Notice of  the  determination  of  the  patient's
  suitability  made  by  the director shall be given to the mental hygiene
  legal service. If the mental hygiene legal service finds that  there  is
  any  ground  to doubt the director's determination of the suitability of
  such patient to remain on such status, or the willingness of the patient
  to so remain, it shall make an application, upon notice to  the  patient
  and  the  director  of  the facility for a court order determining those
  questions. In any such proceeding, the patient or someone on his  behalf
  or the mental hygiene legal service may request a hearing. If the mental
  hygiene legal service finds no grounds to doubt the determination of the
  director  as  to  the  suitability  or the willingness of the patient to
  continue on conditional release status, it  shall  so  certify  and  the
  patient may be continued on such status. A copy of such certification of
  review shall be filed in the patient's record.
    2.  If  an  application for a court order has been made, the court, in
  determining  the  proceeding,  may  approve  the  continued  conditional
  release  of  the  patient or, if the court finds that the patient is not
  suitable or willing to continue on conditional release  status,  it  may
  order the discharge of such patient.
    3.  Prior  to  the  termination  of twelve months from the date of the
  certification by the mental hygiene legal service of such  first  review
  or,  if an application for a court order has been made, from the date of
  the first order and, thereafter, prior  to  the  termination  of  twelve
  months  from  any  subsequent  certification or subsequent order, as the
  case  may  be,  the  director and the mental hygiene legal service shall
  conduct another review of the patient's suitability and  willingness  to
  remain  on  conditional  release  status,  as set forth in the foregoing
  subdivisions.
    (e) * 1. In the case of an involuntary patient on conditional release,
  the director may terminate the conditional release and order the patient
  to return to the facility at  any  time  during  the  period  for  which
  retention  was  authorized,  if, in the director's judgment, the patient
  needs in-patient care and treatment and the conditional  release  is  no
  longer  appropriate;  provided,  however,  that  in  any  such case, the
  director shall cause written notice of such patient's return to be given
  to the mental hygiene  legal  service.  The  director  shall  cause  the
  patient  to  be retained for observation, care and treatment and further
  examination in a hospital for up to seventy-two hours if a physician  on
  the  staff of the hospital determines that such person may have a mental
  illness and may be in need  of  involuntary  care  and  treatment  in  a
  hospital pursuant to the provisions of article nine of this chapter. Any
  continued retention in such hospital beyond the initial seventy-two hour
  period  shall  be  in  accordance  with  the  provisions of this chapter
  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
  chapter, and does not agree to stay in the hospital as  a  voluntary  or
  informal  patient,  he  or she must be released, either conditionally or
  unconditionally.
    * NB Effective until June 30, 2010
    * 1. In the case of an involuntary patient on conditional release, the
  director may terminate the conditional release and order the patient  to
  return to the facility at any time during the period for which retention
  was  authorized,  if,  in  the  director's  judgment,  the patient needs
  in-patient care and treatment and the conditional release is  no  longer
  appropriate provided, however, that in any such case, the director shall
  cause  written notice of such patient's return to be given to the mental
  hygiene legal service. If, at any time prior to the expiration of thirty
  days from the date of return to the facility,  he  or  any  relative  or
  friend  or  the  mental hygiene legal service gives notice in writing to
  the director of request for hearing on the question of  the  suitability
  of  such  patient's  return  to  the  facility,  a hearing shall be held
  pursuant to the provisions of this chapter relating to  the  involuntary
  admission of a person.
    * NB Effective June 30, 2010
    2.  In  the  case  of  a voluntary patient on conditional release, the
  director may terminate the conditional release and order the patient  to
  return to the facility at any time, if, in the judgment of the director,
  the  patient  needs  in-patient  care  and treatment and the conditional
  release is no  longer  appropriate,  provided,  however,  that  if  such
  patient  does  not  consent  to  return to the facility, he shall not be
  returned to the facility, except in accordance with  the  provisions  of
  this chapter and the regulations of the commissioner for the involuntary
  admission of a person.
    (f)   The   discharge   or  conditional  release  of  all  clients  at
  developmental centers, patients at psychiatric centers  or  patients  at
  psychiatric  inpatient  services  subject  to licensure by the office of
  mental health shall  be  in  accordance  with  a  written  service  plan
  prepared  by  staff  familiar  with  the  case  history of the client or
  patient to be discharged or conditionally released  and  in  cooperation
  with  appropriate  social  services  officials  and  directors  of local
  governmental units. In causing such plan to be prepared, the director of
  the  facility  shall take steps to assure that the following persons are
  interviewed, provided an opportunity  to  actively  participate  in  the
  development  of  such  plan  and  advised  of whatever services might be
  available to the patient through the mental hygiene legal  service:  the
  patient  to  be  discharged  or  conditionally  released;  an authorized
  representative of the patient, to include the parent or parents  if  the
  patient  is  a  minor,  unless  such minor sixteen years of age or older
  objects to the participation of the parent or parents and there has been
  a clinical determination by a physician  that  the  involvement  of  the
  parent  or  parents is not clinically appropriate and such determination
  is documented in the clinical record and there is no plan  to  discharge
  or release the minor to the home of such parent or parents; and upon the
  request  of  the  patient  sixteen  years of age or older, a significant
  individual to the  patient  including  any  relative,  close  friend  or
  individual  otherwise  concerned  with the welfare of the patient, other
  than an employee of the facility.
    (g) A written service plan prepared pursuant  to  this  section  shall
  include, but shall not be limited to, the following:
    1.  a  statement  of  the  patient's  need,  if  any, for supervision,
  medication, aftercare services, and  assistance  in  finding  employment
  following discharge or conditional release, and
    2.  a  specific  recommendation  of the type of residence in which the
  patient is to live and a  listing  of  the  services  available  to  the
  patient in such residence.
    3.  A  listing  of  organizations,  facilities, including those of the
  department, and individuals who are available  to  provide  services  in
  accordance with the identified needs of the patient.
    4.  The  notification  of  the  appropriate  school  district  and the
  committee on special  education  regarding  the  proposed  discharge  or
  release  of a patient under twenty-one years of age, consistent with all
  applicable federal and state laws relating to  confidentiality  of  such
  information.
    (5)  an evaluation of the patient's need and potential eligibility for
  public benefits following discharge or  conditional  release,  including
  public assistance, medicaid, and supplemental security income.
    An  inpatient  facility  operated  or licensed by the office of mental
  health shall  provide  reasonable  and  appropriate  assistance  to  the
  patient,  in  cooperation  with  local  social  services  districts,  in
  applying for benefits identified in the written service plan pursuant to
  paragraph five of this subdivision, prior to  discharge  or  conditional
  release.
    (h)  It  shall  also  be  the  responsibility  of  the director of any
  department facility from which a client or patient has  been  discharged
  or  conditionally  released,  in  collaboration,  when appropriate, with
  appropriate  social  services   officials   and   directors   of   local
  governmental  units,  to  prepare,  to  cause  to be implemented, and to
  monitor a comprehensive program designed:
    1. to determine whether the residence in which such client or  patient
  is  living, is adequate and appropriate for the needs of such patient or
  client;
    2. to verify that such patient or client  is  receiving  the  services
  specified in such patient's or client's written service plan; and
    3.  to  recommend,  and  to take steps to assure the provision of, any
  additional services.
    (i) 1. No patient about to be  discharged  or  conditionally  released
  from a department facility or an inpatient facility operated or licensed
  by  the  office  of  mental  health  shall  be  directly referred to any
  facility subject to licensure, certification or approval  by  any  state
  agency  or  department, unless it has been determined that such facility
  has a current and valid license, certificate or approval.  In  addition,
  no  patient  about  to  be  discharged  or conditionally released from a
  department facility  shall  be  directly  referred  to  any  residential
  accommodation not subject to licensure, certification or approval by any
  state  agency  or  department  unless  it  has  been  determined,  after
  consultation with appropriate  local  agencies,  that  such  residential
  accommodation complies with all appropriate local zoning, building, fire
  and safety codes, ordinances and regulations.
    2. (I) A patient about to be discharged or conditionally released from
  a  department  facility  licensed  or  operated  by the office of mental
  retardation and developmental disabilities or from an inpatient facility
  operated or licensed by  the  office  of  alcohol  and  substance  abuse
  services to an adult home or residence for adults, as defined in section
  two  of  the social services law, shall be referred only to such home or
  residence that is consistent with that patient's needs and that operates
  pursuant to section four hundred  sixty  of  the  social  services  law,
  provided  further  that:  (A)  for  a  department  facility  licensed or
  operated  by  the  office  of  mental  retardation   and   developmental
  disabilities  or  for  an  inpatient  facility operated by the office of
  alcohol and substance abuse  services,  the  facility  director  retains
  authority  to  determine  whether  the  home,  program  or  residence is
  consistent with that patient's needs and (B) such referral shall be made
  to the patient's home county whenever possible or appropriate.
    (II) No patient about to be discharged or conditionally released  from
  a  department  facility  licensed  or  operated  by the office of mental
  retardation and developmental disabilities or from an inpatient facility
  operated or licensed by  the  office  of  alcohol  and  substance  abuse
  services shall be referred to any adult home or residence for adults, as
  defined in section two of the social services law, which has received an
  official  written  notice  from  the  department  of  health of: (A) the
  proposed revocation, suspension or denial of its operating  certificate;
  (B)  the  limitation  of  its  operating certificate with respect to new
  admissions; (C)  the  issuance  of  a  department  of  health  order  or
  commissioner  of  health's  order  or  the  seeking  of equitable relief
  pursuant to section four hundred sixty-d of the social services law; (D)
  the proposed  assessment  of  civil  penalties  for  violations  of  the
  provisions  of subparagraph two of paragraph (b) of subdivision seven of
  section four hundred sixty-d of the social services law; or placement on
  the "do not refer list" pursuant to subdivision fifteen of section  four
  hundred  sixty-d  of  the social services law. Referrals may resume when
  such enforcement actions are resolved.
    (III) A community provider of mental  hygiene  services,  including  a
  provider of case management services, which serves residents of any home
  or  residence  in  which  the  department  of  social services has acted
  pursuant to subdivision nine of section four hundred sixty-one-c of  the
  social services law, shall assist the operator of such home or residence
  or the department of social services in efforts to secure an appropriate
  alternate placement of a resident.
    (IV) The commissioner shall promptly refer to the department of social
  services  any  serious  complaint  received  about  the care provided or
  health and safety conditions in an adult home or residence  for  adults.
  The  commissioner  may  as  appropriate  assist the department of social
  services in the investigation and resolution of such complaints as  well
  as  in  the  investigation and resolution of any such complaint which is
  initially received by the department of social services.
    (j) The department shall submit to the legislature and the governor by
  the   first   day   of   January,   nineteen  hundred  seventy-eight,  a
  comprehensive plan describing those reasonable  steps  taken  or  to  be
  taken  by  the  department  to  locate former patients who had been in a
  department facility for a continuous period for two or more years  prior
  to their discharge or conditional release and who had been discharged or
  conditionally  released  on  or  after the thirty-first day of December,
  nineteen hundred seventy without the benefit of a written service  plan.
  In  each  case  in which the person has been located, the department, in
  cooperation with appropriate social services officials and directors  of
  community services, shall make every effort to develop a written service
  plan  for  such  person  and shall assume the same responsibilities with
  respect to such person as the department  is  required  to  assume  with
  respect  to a person who was discharged or conditionally released from a
  department facility pursuant to a written service plan.
    (k) No patient shall be required, as  a  condition  precedent  to  his
  discharge, to agree to the terms of a written service plan. If after the
  advisability  of  following  the program proposed in the written service
  plan has been explained to the patient who has been discharged or who is
  to be discharged, such patient expresses his objection to  such  program
  or  any  part thereof, a notation of such objection shall be made in the
  patient's records.
    (l) Nothing in this section shall be construed to prohibit, limit,  or
  restrict the obligation of the director of a department facility to make
  necessary expenditures for the board and family care of patients subject
  to  the  approval of the commissioner, provided that no such expenditure
  shall be made with respect  to  any  patient  who  is  receiving  public
  assistance and care under the social services law.
    (m)  It  shall be the responsibility of the chief administrator of any
  facility providing inpatient services subject to licensure by the office
  of mental health to notify, when appropriate, the local social  services
  commissioner   and   appropriate   state   and   local   mental   health
  representatives  when  an  inpatient  is  about  to  be  discharged   or
  conditionally  released  and  to  provide  to such officials the written
  service plan developed for such inpatient as required under  subdivision
  (f) of this section.
    (n)  It  shall  be  the  duty  of  directors  of local social services
  districts and local governmental  units  to  cooperate  with  facilities
  licensed  or  operated by an office of the department in the preparation
  and implementation of comprehensive written services plans  as  required
  by this section.