Chapter 477 (Hannon): This chapter enhances infection control training and practices and clarifies and strengthens the authority of the board for professional medical conduct to discipline physicians. Combining provisions from a "safe injection practices" bill (S.8104/Hannon) with a Governor’s Program "patient safety" bill (S.8298), this chapter represents the culmination of diligent and collaborative efforts by the Legislature, Department of Health, medical experts, advocates and the Governor’s office to ensure the safety of New York’s patients. It is a necessary first step toward restoring the public’s faith in a medical profession which has been fractured. Specifically, this chapter improves upon patient safety by clarifying the Department’s authority to take action against physicians who have engaged in poor medical practices; ensuring the public’s access to information regarding a physician’s involvement with disciplinary proceedings while, at the same time, acknowledging that any physician involved in such disciplinary proceedings should be entitled to due process considerations which protect against unsubstantiated complaints; and by improving infection control education and practices, including a study on the efficacy of restricting the use of multi-dose vials and transitioning to the mandatory use of disposable medical equipment engineered for single use.

This legislation significantly enhances New York’s ability to continue to provide a patient centered and safe health care system. This chapter was signed by Governor Paterson on August 5, 2008.

Section one amends subdivision seven of § 230 of the Public Health Law by authorizing the office of professional medical conduct to obtain medical records, and other protected health information pertaining to a licensee’s physical or mental condition, when a committee on professional conduct has reason to believe the licensee may be impaired by alcohol, drugs, physical disability or mental disability, or that information regarding the licensee’s medical condition may be relevant to an inquiry into a report of a communicable disease.

Section three of the bill amends subparagraph (v) of paragraph (a) of subdivision (10) of § 230 of the Public Health Law to provide that in office of professional medical conduct cases and investigations pertaining to a public health threat, the Commissioner of Health is authorized to disclose information to the public as needed, notwithstanding otherwise applicable confidentiality provisions.

One provision in section four of the bill amends subparagraph (iv) of paragraph (a) of subdivision (10) of § 230 of the Public Health Law to provide that if the investigation committee is unanimous in its concurrence that a hearing is warranted, the charges shall be made public. If the investigation committee is not unanimous in its concurrence that a hearing is warranted, the members of such committee shall vote on whether the charges should be made public, and if all of the committee members vote in favor of publication, the charges shall be made public.

A second provision in section four of the bill adds paragraph (vii) to subdivision (10) (a) of § 230 of the Public Health Law to require the office of professional medical conduct, in consultation with the Patient Safety Center of the Department of Health (DOH), to conduct a continuous review of medical malpractice claims and disposition information reported to DOH under § 315 of the Insurance Law, to identify potential misconduct, and when found, conduct an investigation.

Section six of the bill amends paragraph (d) of subdivision (10) of § 230 of the Public Health Law to provide that the charges in professional discipline proceedings shall be made public, pursuant to the conditions described in subparagraph (iv) of paragraph (a) of subdivision (10) of § 230 of the Public Health Law, no earlier than five business days after such charges are served upon the licensee.

Section eleven of the bill amends paragraph (a) of subdivision (12) of § 230 of the Public Health Law by authorizing the Commissioner of Health, after being presented with information that a physician is causing, engaging in or maintaining a condition that has or is likely to lead to transmission of a communicable disease or HIV, and it would not be in the public's interest to delay action until a hearing, to order the physician to immediately discontinue such dangerous activity or take other action.

Section fifteen of the bill amends § 230-d of the Public Health Law to require licensees who

conduct office-based surgery to report any suspected transmission of a blood-borne communicable disease resulting from improper infection control practices originating in their practices in connection with such office-based surgery to the Department of Health’s Patient Safety Center within one business day.

Section sixteen of the bill amends § 239 of the Public Health Law to: (1) provide that every medical student, medical resident and physician assistant student, as part of the orientation offered by medical schools, medical residency programs and physician assistant programs, complete course work or training in infection control practices, as currently required for licensees; (2) require that documentation be provided to the Department of Health demonstrating competency in such course work or training; (3) require eligible licensees to reapply for exemptions from such coursework requirements every four years; (4) include HCV, in addition to HIV and HBV, as one of the infections addressed by the required training; and (5) provide that by September 1, 2008 and periodically thereafter, the Department of Health, including the Patient Safety Center and in consultation with the Council on Graduate Medical Education, review and revise the content of infection control training to ensure that it reflects current practices and standards, with a particular emphasis on outpatient and ambulatory settings.

Section seventeen of the bill adds § 239-a to the Public Health Law, which requires the Department of Health to develop evidence-based infection control guidelines, including safe injection practices. The department is directed to distribute the guidelines to physicians and make them available to the public on or before January 1, 2009 and every year thereafter.

Section eighteen of the bill adds § 239-b to the Public Health Law, which requires the Department of Health to conduct a study and report to the Governor and the Legislature by January 1, 2009, on whether restricting the use of multi-dose vials for the packaging of

medications and requiring the use of disposable medical equipment engineered for single use is viable and would improve infection control practices

Create the New York Certified Aide Registry and Employment Search Act

Chapter 594: This chapter establishes the "New York Certified Aide Registry and Employment Search Act."

A recent two-year investigation by the Office of the New York State Attorney General revealed rampant fraud and abuse, including the distribution of fraudulent training certificates to home care aides, within the home health aide industry. The establishment of a central registry will help eliminate such abuse and will require information on the aide’s training and background to be made available, thereby promoting transparency within the industry. This legislation, which specifically requires the registry to include information regarding an aide’s employment history in home care, any care-related governmental findings of physical abuse, mistreatment, neglect, or misappropriation of property perpetrated by the aide, as well as the name of each state approved training program completed by the aide, has garnered broad industry support.

While recognizing that qualified home health care aides provide valuable care for dependent New Yorkers across the state, this legislation seeks to minimize the likelihood that untrained aides are placed in the homes of these vulnerable individuals. Such fraudulent practices undermine the good work the home care industry provides to New Yorkers every day. The home care services worker registry will greatly enhance oversight and accountability in the home care industry by ensuring that workers are officially registered and that providers have access to reliable information regarding the workers they employ.

Signed by Governor Paterson on September 25, 2008, the provisions of this chapter become effective September 25, 2009.

Chapter 262 (Hannon): This chapter authorizes Surrogate Decision Making Committees to make a decision, for persons with mental retardation who are not represented by an involved family member or guardian, to withhold or withdraw life-sustaining treatment.

The Health Care Decisions Act for Persons with Mental Retardation (chapter 500 of the laws of 2002) was enacted to prevent the extreme suffering of individuals with intellectual developmental disabilities who, as a result of such disabilities, are unable to make their end-of-life wishes known in clear and convincing terms. Pursuant to the act (HCDA), guardians and family members are authorized, subject to extreme end-of-life circumstances and rigorous oversight, to make decisions to withdraw or withhold life-sustaining treatment. As it minimizes the likelihood that "mentally retarded patients [are] forced to suffer painful, intrusive life-sustaining medical treatments after it [becomes] clear that they [will] never regain any quality of life" (Matter of M.B., 6 NY3d 437, 440 [2006]), the HCDA has rightfully been described as a comprehensive and compassionate law of landmark proportions in New York State.

This chapter is necessary, however, for those individuals with mental retardation who have no guardian or committed family member to advocate for them. Many are elderly without living family members, while others were institutionalized and abandoned by their families years ago. They, the most vulnerable, are disproportionately victimized by futile medical care which only serves to prolong the agony of death. This chapter, by authorizing Surrogate Decision Making Committees to advocate on their behalf, can rectify this unanticipated injustice.

Signed by Governor Paterson on July 7, 2008, this chapter becomes effective January 3, 2009. (S.7752/A.10833)

This change in law is, furthermore, consistent with changes made to similar programs, such as Bridges to Health for children in foster care, the Nursing Home Transition and Diversion Waiver Program, into which participants of Care at Home may transition, and the Traumatic Brain Injury Waiver Program. New York’s Care at Home program gives families the flexibility to have their children remain at home. This chapter expands that option to even more families, ensuring high quality care in a patient-centered environment. Signed by Governor Paterson on July 21, 2008, this chapter is deemed to have been in effect as of July 1, 2008.

(S.8702/A.11416-A)

Chapter 362 (Hannon): This chapter provides an option to register and enroll in the New York State Donate Life Registry on statewide application forms for voter registration. Thousands of people die every year waiting for donated organs. In New York alone, as demand for organs outpaces supply, nearly 9,000 people are on a waiting list for donated organs. Recognizing that New Yorkers deserve a better opportunity to receive the organs and tissues their health requires, this chapter reduces barriers for individuals to become organ donors by allowing for convenient registration and enrollment in the Donate Life Registry for the hundreds of thousands of New Yorkers who fill out voter registration applications every year. Notably, one organ donor can save or enhance the lives of up to fifty people through an organ or tissue donation that may restore eyesight, help fight infections in burn patients or delay the onset of end-stage organ failure. Signed by Governor Paterson on July 21, 2008, this chapter becomes effective January 1, 2009. (S.7058/A.10301)

Reported rates of chlamydial infections in New York State have steadily increased, rising from 244.5 infections per 100,000 people in 2001 to 356.4 infections per 100,00 people in 2006. Nationally, over one million cases of chlamydia were reported in 2006. Fortunately, chlamydia is easily treated and can be cured with antibiotics. The risk of re-infection, however, particularly for women whose sex partners have not been treated, is high. Recognizing that having multiple infections increases the likelihood a woman will suffer serious reproductive health complications, this chapter authorizes the use of expedited partner therapy by a health care practitioner who diagnoses a sexually transmitted chlamydial infection in an individual patient.

Expedited partner therapy (EPT), the practice of treating the sex partners of persons with sexually transmitted diseases without an intervening medical evaluation, may prove an effective tool in breaking the cycle of chlamydial re-infection. Typically involving patient-delivered partner therapy, wherein a health care practitioner provides medication to the diagnosed individual for his or her partner, the Centers for Disease Control and Prevention (CDC) has concluded EPT should be available to clinicians as an option for partner management of chlamydial infections. The American Medical Association (AMA) has similarly recognized EPT as a valuable tool in promoting public health, observing that "[t]he appropriate use of EPT has resulted in more partner treatment than standard referral of patients among patients infected with [ ] chlamydia" (Report 6-A-08, Council of Ethical and Judicial Affairs, American Medical Association, available at www.ama-assn.org/ama1/pub/upload/mm/471/ceja6.doc). Acknowledging EPT represents a departure from the traditional patient-physician relationship, however, both the CDC and AMA recommend that clinicians employing EPT continue to consider standard patient referral strategies as treatment options.

Recognizing EPT is not intended as a replacement for standard patient referral strategies, and that it has only been proven successful in controlling select sexually transmitted diseases, particularly chlamydia, this legislation will sunset after five years. Signed by Governor Paterson on September 25, 2008, the provisions of this chapter become effective January 23, 2009. (S.6210-A/A.8730-C)

Chapter 210: This chapter authorizes, on a demonstration basis, the use of a simplified advance health care directives form for exclusive use by persons with mental retardation and developmental disabilities. A duly appointed health care agent is not normally authorized to make health care decisions on a principal’s behalf unless and until the principal has been determined to lack capacity. In contrast, the advance health care directives form authorized for use pursuant to this chapter will permit an agent, during the demonstration period, to make health care decisions immediately upon his or her designation as the principal’s proxy. Furthermore, recognizing the value and need of a comprehensive dialogue between principal and agent, particularly within the mentally retarded and developmentally disabled communities exclusively impacted here, the form advanced by this chapter uses elementary school-level language and illustrations to educate such individuals about choosing a health care agent and the health care choices available to them. Thus furthering New York’s established public policy of ensuring that persons with intellectual and other developmental disabilities be granted the right to designate health care agents (Public Health Law § 2991), the simplified advance directives form can provide greater control and independence to individuals whose limitations might otherwise prevent them from making their health care wishes known. Signed by Governor Paterson on July 7, 2008, this chapter shall become effective upon the date of the approval and availability of the simplified advance health care directives form authorized by subdivision (e) of § 33.03 of the mental hygiene law. (S.7751-A/A.11054-A)

Chapter 573: This chapter establishes a process for the department of Health to educate the public about health risks, benefits and choices associated with birthing procedures. Recent data from the National Center for Health Statistics reveals that in 2006 the percentage of cesarean section births in the United States was a record high 31.1%, representing a 3% increase over the 2005 rate and a 50% increase since 1996. Indeed, recent trends show dramatic increases in the utilization of invasive procedures, including induction and elective cesarean sections, while less invasive birthing options and techniques are underutilized.

Such data is alarming because, although cesarean delivery is clearly beneficial in select circumstances, such circumstances are present in only a small percentage of pregnancies. Delivery by cesarean section, furthermore, is accompanied by a variety of health risks for both a mother and her newborn. Cesarean mothers are more likely to experience emergency hysterectomies, blood clotting and strokes, surgical injuries, infection, intense and prolonged postpartum pain as well as chronic pelvic pain and bowel obstruction. Cesarean born babies, meanwhile, are more likely than vaginally born babies to suffer from respiratory problems, experience surgical injuries and have difficulty breastfeeding. Consequently, cesarean mothers and their babies have longer and more frequent hospitalizations which result in greater health care costs to society.

Prior to enactment of this legislation, existing law (Public Health Law §2803-j) required hospitals to share only minimal information with patients concerning birthing statistics, and only under certain circumstances. Reports by the New York City Public Advocate released in July 2005 and December 2006 showed that hospitals in New York City routinely fail to make even this minimal information available to patients. Consequently, women made decisions about their childbirth options without access to this and other important information.

This chapter addresses the above by ensuring maternity patients are equipped with complete information regarding the full range of options available to them, from preconception through the birth. Arming patients with substantive, current information will help them make informed decisions, thus leading to improved birthing outcomes throughout the state. Signed by Governor Paterson on September 25, 2008, the provisions of this chapter became effective immediately. (S.5018-B/A.7674-B)

This legislation expands upon the concept of employee wellness programs by allowing accident and health insurers, medical and health services corporations, and health maintenance organizations to offer similar programs in conjunction with their issuance of group policies or subscriber contracts. Such wellness programs, defined in the bill as those "designed to promote health and prevent disease," are intended to improve the overall health, well-being and quality of life of participants. They may include a smoking cessation component, weight management or stress management services, as well as educational materials regarding the importance of healthy nutrition. Permissible incentives for participation, meanwhile, may include reimbursement for costs associated with participation in smoking cessation and weight management programs or membership in a health club or fitness center, and the waiver or reduction of co-payments, coinsurance and deductibles for preventive services covered under the group policy or subscriber contract.

Signed by Governor Paterson on September 25, 2008, the provisions of this chapter became effective immediately. (S.4675-A/A.10884-A)

Chapter 36: This chapter extends, until March 31, 2013, a demonstration program related to ensuring that physicians who have substance abuse or mental health problems receive appropriate treatment. Originally enacted in 1983, the law exempts members of physician health committees organized within the Medical Society of the State of New York, the New York State Osteopathic Society or county medical societies from certain medical misconduct reporting requirements. A member is not required to report information pertaining to a physician’s alcoholism, drug abuse or mental illness, provided that such information was discovered solely as a result of the member’s participation on the committee. The chapter includes a corresponding extension regarding a requirement that an applicable physician health committee submit a report to the legislature and the commissioner of health detailing its activities. Signed by Governor Paterson on March 31, 2008, this chapter became effective immediately. (S.6999/A.10052)

Under the pre-existing law, a hospital which denies, or refuses to act upon, an application for staff membership or professional privileges from a dentist, optometrist, physician or podiatrist must provide the applicant an explanation of its reasons for doing so (Public Health Law § 2801-b [1]). This chapter adds licensed midwives to the list of professions entitled to such an explanation.

By requiring that a hospital’s consideration of a midwife’s application for staff membership or professional privileges be based on standards of patient care, patient welfare, the objectives of the institution or the character or competency of the applicant, this legislation will ensure that a midwife is not denied membership or privileges based solely on such applicant’s category of licensure.

This chapter allows midwives to practice to the fullest extent of their training and competency, thus enabling them to continue providing quality midwifery services to patients throughout New York State. Signed by Governor Paterson on September 25, 2008, the provisions of this chapter become effective October 25, 2008. (S.4019-A/A.5505-B)

Chapter 32 (Hannon): This chapter amends chapter 621 of the Laws of 2007, which added six persons who have or have had breast cancer and are active in community-based breast cancer organizations to the Health Research Science Board. It clarifies the manner in which such members are appointed. Signed by the governor on March 17, 2008, it is deemed to have been in full force and effect as of August 28, 2007. (S.6552/A.9464)

Chapter 273 (Hannon): This chapter extends, for an additional five years, the authority of the Terence Cardinal Cooke Health Care Center to obtain financing and construction services from the Dormitory Authority of the State of New York (DASNY). Terence Cardinal Cooke Health Care Center is a 729-bed continuing-care facility with a multitude of special care units, as well as two large outpatient clinics. This chapter will ensure it remains eligible to obtain financing and construction services from DASNY, which enhance its ability to provide services to aged, disabled, chronically impaired, mentally retarded and developmentally challenged individuals. Signed by Governor Paterson on July 7, 2008, this chapter became effective immediately. (S.8234/A.11687)