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S03151 Summary:

BILL NOS03151
 
SAME ASSAME AS A02383
 
SPONSORSAVINO
 
COSPNSRALCANTARA, HOYLMAN, KRUEGER
 
MLTSPNSR
 
Add Art 28-F 2899-d - 2899-s, Pub Health L
 
Relates to the medical aid in dying act; relates to a terminally ill patient's request for and use of medication for medical aid in dying.
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S03151 Memo:

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S03151 Text:



 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                          3151
 
                               2017-2018 Regular Sessions
 
                    IN SENATE
 
                                    January 20, 2017
                                       ___________
 
        Introduced  by  Sens. SAVINO, HOYLMAN -- read twice and ordered printed,
          and when printed to be committed to the Committee on Health
 
        AN ACT to amend the public health law, in relation to a  terminally  ill
          patient's request for and use of medication for medical aid in dying
 
          The  People of the State of New York, represented in Senate and Assem-
        bly, do enact as follows:
 
     1    Section 1. This act shall be known and may be cited  as  the  "medical
     2  aid in dying act".
     3    §  2. The public health law is amended by adding a new article 28-F to
     4  read as follows:
     5                                ARTICLE 28-F
     6                            MEDICAL AID IN DYING
     7  Section 2899-d. Definitions.
     8          2899-e. Request process.
     9          2899-f. Attending physician responsibilities.
    10          2899-g. Right to rescind request; requirement to offer  opportu-
    11                    nity to rescind.
    12          2899-h. Consulting physician responsibilities.
    13          2899-i. Referral to mental health professional.
    14          2899-j. Medical record documentation requirements.
    15          2899-k. Form of written request and witness attestation.
    16          2899-l. Protection and immunities.
    17          2899-m. Permissible refusals and prohibitions.
    18          2899-n. Relation to other laws and contracts.
    19          2899-o. Safe disposal of unused medications.
    20          2899-p. Death certificate.
    21          2899-q. Reporting.
    22          2899-r. Penalties.
    23          2899-s. Severability.
    24    § 2899-d. Definitions. As used in this article:
    25    1. "Adult" means an individual who is eighteen years of age or older.
 
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD01103-05-7

        S. 3151                             2
 
     1    2. "Attending physician" means the physician who has primary responsi-
     2  bility for the care of the patient and treatment of the patient's termi-
     3  nal disease.
     4    3.  "Capacity"  or  "capacity  to make an informed decision" means the
     5  ability to understand and appreciate  the  nature  and  consequences  of
     6  health  care decisions, including the benefits and risks of and alterna-
     7  tives to any proposed health care, and to reach an informed decision.
     8    4.   "Consulting physician" means a  physician  who  is  qualified  by
     9  specialty  or  experience to make a professional diagnosis and prognosis
    10  regarding a person's terminal illness.
    11    5. "Health care facility" means a general hospital, nursing  home,  or
    12  residential  health  care  facility  as  defined in section twenty-eight
    13  hundred one of this chapter.
    14    6. "Health care provider"  means  a  person  licensed,  certified,  or
    15  authorized  by  law  to administer health care or dispense medication in
    16  the ordinary course of business or practice of a profession.
    17    7.  "Informed decision" means a decision by a patient who is suffering
    18  from a terminal illness to request and obtain a prescription for medica-
    19  tion that the patient may self-administer to end the patient's life that
    20  is based on an understanding and acknowledgment of  the  relevant  facts
    21  and that is made after being fully informed of:
    22    (a) the patient's medical diagnosis and prognosis;
    23    (b)  the  potential  risks associated with taking the medication to be
    24  prescribed;
    25    (c) the probable result of taking the medication to be prescribed;
    26    (d) the possibility that the patient may  choose  not  to  obtain  the
    27  medication,  or may obtain the medication but may decide not to self-ad-
    28  minister it; and
    29    (e) the feasible alternatives or additional  treatment  opportunities,
    30  including palliative care and hospice care.
    31    8.  "Medical  aid  in dying" means the medical practice of a physician
    32  prescribing medication to a qualified individual that the individual may
    33  choose to self-administer to bring about death.
    34    9. "Medically confirmed" means the medical opinion  of  the  attending
    35  physician  that a patient has a terminal illness has been confirmed by a
    36  consulting physician who has examined  the  patient  and  the  patient's
    37  relevant medical records.
    38    10. "Medication" means medication prescribed by a physician under this
    39  article.
    40    11.  "Mental health professional" means a physician, nurse practition-
    41  er, physician assistant or psychologist, licensed or certified under the
    42  education law acting within his or her scope  of  practice  and  who  is
    43  qualified,  by  training and experience, certification, or board certif-
    44  ication or eligibility, to make a determination  under  section  twenty-
    45  eight  hundred  ninety-nine-i of this article; provided that in the case
    46  of a nurse practitioner or physician assistant, the  professional  shall
    47  not have a collaborative agreement or collaborative relationship with or
    48  be supervised by the attending physician or consulting physician.
    49    12. "Palliative care" means health care treatment, including interdis-
    50  ciplinary  end-of-life  care,  and consultation with patients and family
    51  members, to prevent or relieve pain and suffering  and  to  enhance  the
    52  patient's quality of life, including hospice care under article forty of
    53  this chapter.
    54    13.  "Patient"  means  a  person who is eighteen years of age or older
    55  under the care of a physician.

        S. 3151                             3
 
     1    14. "Physician" means an individual licensed to practice  medicine  in
     2  New York state.
     3    15.  "Qualified  individual"  means a patient with a terminal illness,
     4  who has capacity, has made an informed decision, and has  satisfied  the
     5  requirements of this article in order to obtain a prescription for medi-
     6  cation.
     7    16.  "Self-administer"  means  a  qualified  individual's affirmative,
     8  conscious, and voluntary act of using medication under this article.
     9    17. "Terminal illness" means an illness that will,  within  reasonable
    10  medical  judgment,  result  in  death  within six months, whether or not
    11  treatment is provided.
    12    § 2899-e. Request process.   1. Oral and written  request.  A  patient
    13  wishing  to  request  medication  under  this article shall make an oral
    14  request and submit a written request to the patient's  attending  physi-
    15  cian.
    16    2.  Making a written request. A patient may make a written request for
    17  and consent to self-administer medication for the purpose of ending  his
    18  or her life in accordance with this article if the patient:
    19    (a)  has been determined by the attending physician to have a terminal
    20  illness and which has been medically confirmed by  a  consulting  physi-
    21  cian; and
    22    (b) voluntarily expresses the request for medication.
    23    3.  Written  request  signed  and witnessed. (a) A written request for
    24  medication under this article shall be signed and dated by  the  patient
    25  and  witnessed  by  at  least  two  adults  who,  in the presence of the
    26  patient, attest that to the best of his or her knowledge and belief  the
    27  patient has capacity, is acting voluntarily, and is not being coerced to
    28  sign the request. The written request shall be in substantially the form
    29  described in section twenty-eight hundred ninety-nine-k of this article.
    30    (b) One of the witnesses shall be an adult who is not:
    31    (i) a relative of the patient by blood, marriage or adoption;
    32    (ii)  a person who at the time the request is signed would be entitled
    33  to any portion of the estate of the patient upon death under any will or
    34  by operation of law; or
    35    (iii) an owner, operator or employee of a health care  facility  where
    36  the patient is receiving treatment or is a resident.
    37    (c)  The attending physician, consulting physician and, if applicable,
    38  the mental health professional who provides a capacity determination  of
    39  the patient under this article shall not be a witness.
    40    4. No person shall qualify for medical aid in dying under this article
    41  solely because of age or disability.
    42    § 2899-f. Attending   physician  responsibilities.  1.  The  attending
    43  physician shall:
    44    (a) make the  determination  of  whether  a  patient  has  a  terminal
    45  illness,  has  capacity,  has made an informed decision and has made the
    46  request voluntarily and without coercion;
    47    (b) inform the patient of  the  requirement  under  this  article  for
    48  confirmation  by  a  consulting  physician,  and  refer the patient to a
    49  consulting physician upon the patient's request;
    50    (c) refer the patient to a  mental  health  professional  pursuant  to
    51  section  twenty-eight  hundred  ninety-nine-i  of  this  article  if the
    52  attending physician believes that the patient lacks capacity to make  an
    53  informed decision;
    54    (d)  provide  information  and  counseling  under  section twenty-nine
    55  hundred ninety-seven-c of this chapter;

        S. 3151                             4

     1    (e) ensure that the patient is making an informed decision by discuss-
     2  ing with the patient: (i) the patient's medical diagnosis and prognosis;
     3  (ii) the potential risks associated with taking  the  medication  to  be
     4  prescribed;  (iii)  the  probable  result of taking the medication to be
     5  prescribed;  (iv)  the possibility that the patient may choose to obtain
     6  the medication but not take it; and (v)  the  feasible  alternatives  or
     7  additional treatment opportunities, including but not limited to pallia-
     8  tive care and hospice care;
     9    (f) discuss with the patient the importance of:
    10    (i)  having  another person present when the patient takes the medica-
    11  tion; and
    12    (ii) not taking the medication in a public place;
    13    (g) inform the patient that he or she  may  rescind  the  request  for
    14  medication at any time and in any manner;
    15    (h)  fulfill  the medical record documentation requirements of section
    16  twenty-eight hundred ninety-nine-j of this article; and
    17    (i) ensure that all appropriate steps are carried  out  in  accordance
    18  with this article before writing a prescription for medication.
    19    2.  Upon  receiving  confirmation  from  a  consulting physician under
    20  section twenty-eight hundred ninety-nine-h of this article  and  subject
    21  to  section  twenty-eight  hundred  ninety-nine-i  of  this article, the
    22  attending physician who makes the determination that the patient  has  a
    23  terminal  illness, has capacity and has made a request for medication as
    24  provided in this article, may personally,  or  by  referral  to  another
    25  physician,  prescribe or order appropriate medication in accordance with
    26  the patient's request under this article, and at the patient's  request,
    27  facilitate  the  filling of the prescription and delivery of the medica-
    28  tion to the patient.
    29    3. In accordance with the direction of  the  prescribing  or  ordering
    30  physician  and the consent of the patient, the patient may self-adminis-
    31  ter the medication to himself or herself. A health care professional  or
    32  other person shall not administer the medication to the patient.
    33    § 2899-g. Right  to  rescind request; requirement to offer opportunity
    34  to rescind.  1. A patient may at any time rescind his or her request for
    35  medication under this article without regard to the patient's capacity.
    36    2. A prescription for  medication  may  not  be  written  without  the
    37  attending  physician offering the qualified individual an opportunity to
    38  rescind the request.
    39    § 2899-h. Consulting physician responsibilities. Before a patient  who
    40  is requesting medication may receive a prescription for medication under
    41  this article, a consulting physician must:
    42    1. examine the patient and his or her relevant medical records;
    43    2.  confirm,  in  writing,  to  the  attending physician: (a) that the
    44  patient has a terminal illness;  (b)  that  the  patient  is  making  an
    45  informed  decision;  (c)  that  the  patient  has  capacity,  or provide
    46  documentation that the consulting physician has referred the patient for
    47  a determination under section twenty-eight hundred ninety-nine-i of this
    48  article; and (d) that the patient  is  acting  voluntarily  and  without
    49  coercion.
    50    § 2899-i. Referral  to mental health professional. 1. If the attending
    51  physician or the consulting physician believes that the patient may lack
    52  capacity, the attending physician or consulting  physician  shall  refer
    53  the  patient  to  a  mental  health  professional for a determination of
    54  whether the patient has capacity. The referring physician  shall  advise
    55  the  patient  that  the report of the mental health professional will be
    56  provided to the attending physician and the consulting physician.

        S. 3151                             5
 
     1    2. A mental health professional who evaluates  a  patient  under  this
     2  section  shall  report,  in  writing, to the attending physician and the
     3  consulting physician, his or her conclusions about whether  the  patient
     4  has capacity to make an informed decision.  If the mental health profes-
     5  sional  determines  that  the patient lacks capacity to make an informed
     6  decision, the patient shall not be deemed a  qualified  individual,  and
     7  the attending physician shall not prescribe medication to the patient.
     8    § 2899-j. Medical  record  documentation  requirements.  An  attending
     9  physician shall document or file the following in the patient's  medical
    10  record:
    11    1.  the dates of all oral requests by the patient for medication under
    12  this article;
    13    2. the written request by the patient for medication under this  arti-
    14  cle;
    15    3. the attending physician's diagnosis and prognosis, determination of
    16  capacity,  and  determination that the patient is acting voluntarily and
    17  without coercion, and has made an informed decision;
    18    4. if applicable, written confirmation of capacity under section twen-
    19  ty-eight hundred ninety-nine-i of this article; and
    20    5. a note by the attending physician indicating that all  requirements
    21  under this article have been met and indicating the steps taken to carry
    22  out  the  request,  including a notation of the medication prescribed or
    23  ordered.
    24    § 2899-k. Form of  written  request  and  witness  attestation.  1.  A
    25  request  for medication under this article shall be in substantially the
    26  following form:
    27                    REQUEST FOR MEDICATION TO END MY LIFE
 
    28    I, _________________________________, am an adult  who  has  capacity,
    29  which  means  I understand and appreciate the nature and consequences of
    30  health care decisions, including the benefits and risks of and  alterna-
    31  tives to any proposed health care, and to reach an informed decision and
    32  to communicate health care decisions to a physician.
    33    I  am  suffering  from ______________________________________________,
    34  which my attending physician has determined is a terminal illness, which
    35  has been medically confirmed by a consulting physician.
    36    I have been fully informed of my diagnosis and prognosis,  the  nature
    37  of  the  medication to be prescribed and potential associated risks, the
    38  expected result, and the feasible  alternatives  or  treatment  opportu-
    39  nities including palliative care and hospice care.
    40    I  request  that my attending physician prescribe medication that will
    41  end my life if I choose to take it, and I authorize my attending  physi-
    42  cian to contact another physician or any pharmacist about my request.
 
    43    INITIAL ONE:
    44    (  ) I have informed or intend to inform my family of my decision.
    45    (  ) I have decided not to inform my family of my decision.
    46    (  ) I have no family to inform of my decision.
    47    I  understand that I have the right to rescind this request or decline
    48  to use the medication at any time.
    49    I understand the importance of this request, and I expect to die if  I
    50  take the medication to be prescribed. I further understand that although
    51  most  deaths  occur within three hours, my death may take longer, and my
    52  attending physician has counseled me about this possibility.
    53    I make this request voluntarily, and  without  being  coerced,  and  I
    54  accept full responsibility for my actions.

        S. 3151                             6
 
     1  Signed: __________________________
 
     2  Dated: ___________________________

     3                          DECLARATION OF WITNESSES
 
     4    I  declare that the person signing this "Request for Medication to End
     5  My Life":
     6    (a) is personally known to me or has provided proof of identity;
     7    (b) voluntarily signed the "Request for Medication to End My Life"  in
     8  my presence or acknowledged to me that he or she signed it; and
     9    (c)  to  the  best of my knowledge and belief, has capacity and is not
    10  being coerced to sign the "Request for Medication to End My Life".
    11    I am not the attending physician or consulting physician of the person
    12  signing the "Request for Medication to End My Life" or,  if  applicable,
    13  the  mental health professional who provides a capacity determination of
    14  the person signing the "Request for Medication to End My  Life"  at  the
    15  time the "Request for Medication to End My Life" was signed.
 
    16         ________________________ Witness 1, Date: ________________
 
    17         ________________________ Witness 2, Date: _________________
 
    18    NOTE:  Only  one of the two witnesses may (i) be a relative (by blood,
    19  marriage or adoption) of the person signing the "Request for  Medication
    20  to  End My Life", (ii) be entitled to any portion of the person's estate
    21  upon death under any will or by operation of law, or (iii) own, operate,
    22  or be employed at a health care facility where the person  is  receiving
    23  treatment or is a resident.
    24    2. (a) The "Request for Medication to End My Life" shall be written in
    25  the  same  language  as any conversations, consultations, or interpreted
    26  conversations or consultations between a patient and at least one of his
    27  or her attending or consulting physicians.
    28    (b) Notwithstanding paragraph (a) of  this  subdivision,  the  written
    29  "Request  for Medication to End My Life" may be prepared in English even
    30  when the conversations or consultations or interpreted conversations  or
    31  consultations  were  conducted  in  a language other than English if the
    32  English language form includes an attached declaration by the interpret-
    33  er of the conversation or consultation, which shall be in  substantially
    34  the following form:
 
    35                          INTERPRETER'S DECLARATION

    36    I, _______[insert name of interpreter]______, am fluent in English and
    37  [insert target language].
    38    On  [insert date], at approximately [insert time], I read the "Request
    39  for Medication to End My Life" to [name of patient]  in  [insert  target
    40  language].
    41    [Name of patient] affirmed to me that he/she understood the content of
    42  the  "Request for Medication to End My Life" and affirmed his/her desire
    43  to sign the "Request for Medication to  End  My  Life"  voluntarily  and
    44  without  coercion  and that the request to sign the "Request for Medica-
    45  tion to End My Life" followed discussions  with  his/her  attending  and
    46  consulting physicians.

        S. 3151                             7
 
     1    I declare that I am fluent in English and [insert target language] and
     2  further  declare under penalty of perjury that the foregoing is true and
     3  correct and that false statements made herein are punishable.
 
     4  Executed  at  [insert  city,  county  and  state] on this [insert day of
     5  month] of [insert month], [insert year].
 
     6  __________________________ [Signature of Interpreter]
 
     7  __________________________ [Printed name of Interpreter]
 
     8  __________________________ [Address of Interpreter]
 
     9  __________________________

    10    (c) An interpreter whose services are provided under paragraph (b)  of
    11  this  subdivision  shall not (i) be related to the patient who signs the
    12  "Request for Medication to End My Life" by blood, marriage or  adoption,
    13  (ii) be entitled at the time the "Request for Medication to End My Life"
    14  is  signed  by  the  patient to any portion of the estate of the patient
    15  upon death under any will or by operation of law, or (iii) be an  owner,
    16  operator  or  employee  of  a  health care facility where the patient is
    17  receiving treatment or is a resident.
    18    § 2899-l. Protection and immunities. 1. A physician, pharmacist, other
    19  health care professional or other person shall not be subject  to  civil
    20  or criminal liability or professional disciplinary action by any govern-
    21  ment  entity  for taking any reasonable good-faith action or refusing to
    22  act under this article, including, but not limited to:  (a) engaging  in
    23  discussions with a patient relating to the risks and benefits of end-of-
    24  life options in the circumstances described in this article, (b) provid-
    25  ing  a  patient,  upon  request,  with a referral to another health care
    26  provider, (c) being present when a qualified individual self-administers
    27  medication, (d) refraining from acting to prevent the qualified individ-
    28  ual from self-administering such  medication,  or  (e)  refraining  from
    29  acting  to resuscitate the qualified individual after he or she self-ad-
    30  ministers such medication.
    31    2. Nothing in this section shall limit civil or criminal liability for
    32  negligence, recklessness or intentional misconduct.
    33    § 2899-m. Permissible refusals and prohibitions. 1. (a)  A  physician,
    34  nurse,  pharmacist, other health care provider or other person shall not
    35  be under any duty, by law or contract, to participate in  the  provision
    36  of medication to a patient under this article.
    37    (b) If a health care provider is unable or unwilling to participate in
    38  the  provision  of  medication  to  a patient under this article and the
    39  patient transfers care to a new health care provider, the  prior  health
    40  care  provider shall transfer or arrange for the transfer, upon request,
    41  of a copy of the patient's relevant medical records to  the  new  health
    42  care provider.
    43    2.(a)  A  private  health  care facility may prohibit the prescribing,
    44  dispensing, ordering or  self-administering  of  medication  under  this
    45  article  while  the  patient is being treated in or while the patient is
    46  residing in the health care facility if:
    47    (i) the prescribing, dispensing,  ordering  or  self-administering  is
    48  contrary  to a formally adopted policy of the facility that is expressly
    49  based on sincerely held religious beliefs or moral  convictions  central
    50  to the facility's operating principles; and

        S. 3151                             8

     1    (ii)  the  facility  has  informed the patient of such policy prior to
     2  admission or as soon as reasonably possible.
     3    (b) Where a facility has adopted a prohibition under this subdivision,
     4  if  a  patient who wishes to use medication under this article requests,
     5  the patient shall be transferred promptly to another health care facili-
     6  ty that is reasonably accessible under the circumstances and willing  to
     7  permit  the  prescribing, dispensing, ordering and self-administering of
     8  medication under this article with respect to the patient.
     9    3. Where a health care facility has adopted a prohibition  under  this
    10  subdivision,  any  health  care provider or employee of the facility who
    11  violates the prohibition may be subject to sanctions otherwise available
    12  to the facility, provided  the  facility  has  previously  notified  the
    13  health care provider or employee of the prohibition in writing.
    14    § 2899-n. Relation  to other laws and contracts.  1. (a) A patient who
    15  requests medication under  this  article  shall  not,  because  of  that
    16  request, be considered to be a person who is suicidal, and self-adminis-
    17  tering  medication under this article shall not be deemed to be suicide,
    18  for any purpose.
    19    (b) Action  taken  in  accordance  with  this  article  shall  not  be
    20  construed  for  any  purpose  to  constitute  suicide, assisted suicide,
    21  attempted suicide, promoting a suicide attempt, mercy killing, or  homi-
    22  cide  under  the  law, including as an accomplice or accessory or other-
    23  wise.
    24    2. (a) No provision in a contract, will or  other  agreement,  whether
    25  written  or  oral,  to  the  extent the provision would affect whether a
    26  person may make or rescind a request for medication or  take  any  other
    27  action under this article, shall be valid.
    28    (b)  No  obligation  owing  under any contract shall be conditioned or
    29  affected by the making or rescinding of a request by a person for  medi-
    30  cation or taking any other action under this article.
    31    3. (a) A person and his or her beneficiaries shall not be denied bene-
    32  fits  under a life insurance policy for actions taken in accordance with
    33  this article.
    34    (b) The sale, procurement or issuance of a life or health insurance or
    35  annuity policy, or the rate charged for a policy may not be  conditioned
    36  upon or affected by a patient making or rescinding a request for medica-
    37  tion under this article.
    38    4. An insurer shall not provide any information in communications made
    39  to  a  patient  about  the availability of medication under this article
    40  absent a request by the patient or by his  or  her  attending  physician
    41  upon  the  request  of such patient. Any communication shall not include
    42  both the denial of coverage for treatment  and  information  as  to  the
    43  availability of medication under this article.
    44    5.  The  sale,  procurement,  or issue of any professional malpractice
    45  insurance policy or the rate charged for the policy shall not be  condi-
    46  tioned  upon or affected by whether the insured does or does not take or
    47  participate in any action under this article.
    48    § 2899-o. Safe disposal of unused medications.  The  department  shall
    49  make  regulations  providing for the safe disposal of unused medications
    50  prescribed, dispensed or ordered under this article.
    51    § 2899-p. Death certificate.  1. If otherwise authorized by  law,  the
    52  attending  physician  may  sign the qualified individual's death certif-
    53  icate.
    54    2. The cause of death listed on a qualified individual's death certif-
    55  icate who dies after self-administering medication  under  this  article
    56  will be the underlying terminal illness.

        S. 3151                             9
 
     1    § 2899-q. Reporting.  1.  The  commissioner  shall  annually  review a
     2  sample of the records  maintained  under  section  twenty-eight  hundred
     3  ninety-nine-j  of this article. The commissioner shall adopt regulations
     4  establishing reporting requirements for physicians taking  action  under
     5  this  article to determine utilization and compliance with this article.
     6  The information collected under this  section  shall  not  constitute  a
     7  public  record available for public inspection and shall be confidential
     8  and collected and maintained in a manner that protects  the  privacy  of
     9  the  patient,  his or her family, and any health care provider acting in
    10  connection with such patient under this article, except that such infor-
    11  mation may be disclosed  to  a  governmental  agency  as  authorized  or
    12  required  by  law  relating  to  professional  discipline, protection of
    13  public health or law enforcement.
    14    2. The commissioner shall prepare a report annually  containing  rele-
    15  vant  data  regarding  utilization  and compliance with this article and
    16  shall post such report on the department's website.
    17    § 2899-r. Penalties. 1. Nothing in this article shall be construed  to
    18  limit  professional discipline or civil liability resulting from conduct
    19  in violation of this article, negligent conduct, or intentional  miscon-
    20  duct by any person.
    21    2. Conduct in violation of this article shall be subject to applicable
    22  criminal  liability  under  state  law, including, where appropriate and
    23  without limitation, offenses constituting homicide,  forgery,  coercion,
    24  and related offenses, or federal law.
    25    § 2899-s. Severability. If any provision of this article or any appli-
    26  cation  of  any  provision of this article, is held to be invalid, or to
    27  violate or be inconsistent with any  federal  law  or  regulation,  that
    28  shall not affect the validity or effectiveness of any other provision of
    29  this article, or of any other application of any provision of this arti-
    30  cle,  which  can  be given effect without that provision or application;
    31  and to that end, the provisions and applications  of  this  article  are
    32  severable.
    33    § 3. This act shall take effect immediately.
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