Section 33.03. Quality of care and treatment

(a)  Each patient in a facility and each person receiving services for
  mental disability shall receive care and treatment that is suited to his
  needs and  skillfully,  safely,  and  humanely  administered  with  full
  respect for his dignity and personal integrity.
    (b)  Subject  to  regulations  of  the commissioner, the director of a
  facility shall require the following in order to  assure  protection  of
  patients in their care and treatment:
    1.  careful reexamination and evaluation of each patient not less than
  once a year.
    2.  medical  and  dental  evaluations  and   evaluations   of   mental
  disabilities of inpatients by qualified professionals no less frequently
  than once a year.
    3.  the  order  of  a  staff  member  operating  within the scope of a
  professional license for any treatment or therapy based  on  appropriate
  examination.
    4.  consent  for  surgery, shock treatment, major medical treatment in
  the nature of surgery, or the use of experimental drugs or procedures.
    5. inclusion in the patient's clinical record of all written treatment
  plans and notation of examinations, individualized  treatment  programs,
  evaluations  and  reexaminations,  orders  for  treatment,  and specific
  therapies, signed by the personnel involved.
    (c) A patient who is removed, but not discharged, from a  hospital  to
  receive medical or surgical care at a facility, at a hospital as defined
  in article twenty-eight of the public health law, or at the offices of a
  health  care  professional,  shall  remain  subject to the provisions of
  article nine of this chapter. During the period of time that the patient
  is removed for the purpose of receiving such medical or  surgical  care,
  all  of  the patient's rights enumerated by article nine of this chapter
  shall be preserved. Nothing in this subdivision shall  be  construed  to
  affect  the  status  or  rights of a patient pursuant to article nine of
  this chapter, who is removed, but not discharged  from  a  hospital  for
  other purposes.
    (d)  The  commissioner shall promulgate and administer regulations and
  policies for the establishment  of  minimum  standards  for  the  active
  programming of patients in adult psychiatric centers.
    1. Such standards shall take into account the: medical, psychological,
  social,  vocational,  educational  and  recreational  needs  of patients
  including the specialized needs of patients such as those  whose  mental
  illness  is  combined  with  chemical  dependency, mental retardation or
  developmental disability. The standards shall also take into account the
  type and  mix  of  programs  required  at  a  given  facility,  and  the
  availability of programming at a variety of times and locations.
    2.  Such  standards  shall  include  but  not be limited to, a minimum
  number of required hours of programming per patient per week  and  staff
  requirements  based on the type of programming and the needs of patients
  served. Such standards shall  provide  for  programming  exemptions  for
  patients   whose   clinical   or   medical   condition  renders  program
  participation  inappropriate  and  for  the  regular  review  of   those
  exemptions.   Additionally,   a  patient  may  refuse  participation  in
  programming provided  however  that  such  refusal  is  consistent  with
  applicable  provisions  of  law.  The regulations shall also provide for
  routine evaluations of the implementation of  scheduled  programming  as
  well as its effect on identified patient needs.
    * (e)  1. Notwithstanding the provisions of subdivisions four and five
  of section twenty-nine hundred eighty-one of the public health law,  the
  commissioners  of  health,  and  mental  retardation  and  developmental
  disabilities may approve and authorize the use of a  simplified  advance

  health  care  directives form by persons receiving supports and services
  from a provider of services which  is  authorized  to  provide  services
  pursuant to article sixteen of this chapter. Such form shall specify, at
  the  option  of  the  principal,  what  end-of-life treatment the person
  wishes to receive; may designate a health care agent consistent with the
  provisions of this article; and may, at the  option  of  the  principal,
  authorize the health care agent to commence making decisions immediately
  upon  the  execution of the proxy, provided that all such decisions made
  prior to a determination of incapacity pursuant to  section  twenty-nine
  hundred  eighty-three  of  the public health law shall be made in direct
  consultation  with  the  principal  and  the  attending  physician;  and
  provided,  further,  that  if,  after  such  consultation, the principal
  disagrees with the agent's proposed  decision,  the  principal's  wishes
  shall  prevail; and provided, further, that, in the case of any decision
  to  withhold  or  withdraw  artificial  nutrition  or   hydration,   the
  principal's  wishes must have been recorded in the health care directive
  or stated in the presence of the agent and the attending physician;  and
  further,  provided,  that  the  consultation  among principal, agent and
  attending physician must be summarized and recorded in  the  principal's
  medical record.
    2.  The  simplified advance health care directives form, authorized by
  paragraph  one  of  this  subdivision,  shall  be   developed   by   the
  commissioner  of  mental  retardation and developmental disabilities, in
  consultation with the  commissioner  of  health,  providers  of  service
  authorized  to  provide  services  pursuant  to  article sixteen of this
  chapter, advocates, including self-advocates,  and  parents  and  family
  members of persons receiving services from such providers.
    * NB  Effective  upon the date of the approval and availability of the
  simplified advance  health  care  directives  form  authorized  by  this
  subdivision and repealed 2 years after such date.
    * NB There are 2 sb (e)'s
    * (e)  Meals provided by a facility in furtherance of a person's right
  to a balanced and nutritious diet, as required by section 33.02 of  this
  article,  shall be served at appropriate times and in as normal a manner
  as possible. Altering the composition  or  timing  of  regularly  served
  meals  shall  be prohibited for disciplinary or punishment purposes, the
  convenience of the staff, or behavior modification. Restrictions may  be
  made  for  clinical  reasons,  pursuant  to documentation by a qualified
  professional, which shall specify the  clinical  justification  for  the
  restriction  and  the  time  period  that  such  restriction shall be in
  effect,  and  which  shall  be  included  in  the  individual's  written
  treatment or services plan.
    * NB There are 2 sb (e)'s