NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A5332A
SPONSOR: Gottfried TITLE OF BILL: An act to amend the public health law, in relation to
the use of psychotropic medications in nursing homes and adult care
facilities
PURPOSE OR GENERAL IDEA OF BILL:
To require an enhanced level of informed consent before psychotropic
medication can be prescribed for patients residing in nursing homes or
adult care facilities.
SUMMARY OF SPECIFIC PROVISIONS:
Would add a new section 280-d to article 2-A of the Public Health Law to
detail the information that must be provided before a health care
professional may prescribe a psychotropic medication and require a writ-
ten informed consent before the initial order, or before an increase in
the dose or duration of an existing order.
The bill accommodates the need of patients who lack capacity and have
lawful representation by a health care agent or surrogate. It provides
notification within 48 hours of an order for a psychotropic medication
to family members who have requested and are lawfully permitted to
receive such notice. It establishes requirements for record keeping in
relation to such medication orders and the contingent informed consent.
Finally, the bill allows for an emergency order for psychotropic medica-
tion where it is reasonably necessary to protect the life, health or
safety of the patient or others, with prompt notification to lawful
representatives and family members lawfully permitted to receive such
notice
JUSTIFICATION:
Under section 2803-c(3) of the Public Health Law, patients residing in
nursing homes have the right to be fully informed of their condition and
any proposed treatment, to refuse treatment, and to be free from chemi-
cal restraints unless such a prescription is consistent with certain
requirements that limit duration and guide use necessitated by an emer-
gency. Psychotropic medications are drugs that affect brain activities
associated with mental processes and behavior including antipsychotics,
antidepressants, antianxiety drugs and hypnotics.
Spurred by published reports, the Assembly Committee on Health held a
public hearing in February 2015 to examine the use of psychotropic drugs
in nursing homes. Consensus emerged that in far too many instances,
psychotropic drugs are used without a differential diagnosis of mental
illness, in order to quiet and calm patients who may be simply upset or
excitable. Given that activities and diversions have been proven to
effectively reduce disruptions related to simple anxiety, dementia and
emotional upset, it is not in many patients' interest to expose them to
the dangerous side effects of psychotropic drugs which include cognitive
decline and addiction.
This bill would require that before such drugs are ordered for a patient
residing in a nursing home or an adult care facility, the patient or
their lawful surrogate be fully informed of the nature and seriousness
of his or her condition, the anticipated benefit from the medication,
the dosage and duration of the prescription, the probability, nature and
degree of side effects, the reasonable alternatives to the drug and why
the health care professional prefers the drug in this instance, and that
the patient has the right to refuse consent for the drug, or later to
revoke their consent. The consent would be written.
Adult care facilities, including assisted living and adult homes, share
many similarities with nursing homes in terms of the needs, vulnerabili-
ty and isolation of the residents. It is appropriate to extend the
protections of this legislation to adult care facility residents.
Allowing family members beyond those who are already the health care
agent or surrogate for the patient to require notification adds another
layer of accountability and assures that patients' quality of life will
be protected and optimized.
Reference: Left Behind: The Impact Of The Failure To Fulfill The Promise
of The National Campaign To Improve Dementia Care; Long Term Community
Care Coalition; 12/22/2014.
PRIOR LEGISLATIVE HISTORY:
2015-2016: A.7351 - passed Assembly
FISCAL IMPLICATIONS:
None
EFFECTIVE DATE:
180 days after enactment provided that the Commissioner may make regu-
lations beforehand that would become effective at the same time as the
law.
