N.H. Admin. Code § Cor 303.02 - Involuntary Emergency Medical Treatment

(a) "Emergency" means the physical or mental status of a person under departmental control or patient that, if not treated promptly, will likely result in substantial harm to the individual person under departmental control or patient or others.

(b) "Restraint" means:

(1) Any drug or medication when it:

a. Is used as a restriction to manage an individual's behavior or restrict the individual's freedom of movement; and

b. Is not a standard treatment or dosage for the individual's condition, in that its overall effect reduces an individual's ability to effectively or appropriately interact; or

(2) Any manual method, physical or mechanical device, material, or equipment that immobilizes an individual or reduces the ability of an individual to move his or her arms, legs, head, or other body parts freely but does not include devices, such as orthopedically prescribed devices, surgical dressings or bandages, protective helmets, or other methods that involve the physical holding of an individual, if necessary, for the purpose of:

a. Conducting routine physical examinations or tests;

b. Protecting the individual from falling out of bed; or

c. Permitting the individual to participate in activities without the risk of physical harm.

(c) The department shall maintain the general health and well-being of persons under departmental control and patients of the secure psychiatric unit. Such person whose medical condition requires, in the opinion of the departmental physician, physician's assistant or advanced registered nurse providers, expeditious emergency medical treatment to prevent death, substantial worsening illness or injury, contagion or infection of others, or harm to self or others shall be treated in the least intrusive manner as prescribed by the licensed provider, even over the objection of the person under departmental control or patient, pursuant to RSA 627:6, VII (b).

(d) In the case of an incompetent person under departmental control or patient, pursuant to RSA 627:6, VII(b), emergency treatment shall be administered when the physician, physician's assistant or ARNP licensed provider reasonably believes that a reasonable person concerned for the welfare of the person under departmental control would consent. Legally responsible persons shall be notified before the proposed treatment, if possible, but in no event later than 24 hours after the administration of such treatment.

(e) Involuntary emergency treatment, seclusion, or restraint in a facility shall not be implemented unless a licensed provider determines that a personal safety emergency exists. Involuntary emergency medical and psychiatric treatment shall be administered by a licensed provider only upon personal examination or observation prior to the decision to administer such treatment, except in situations where emergency physical or mechanical restraint or seclusion is necessary as described in (k) below.

(f) Involuntary emergency medical treatment, pursuant to RSA 627:6, VII (b) shall be limited to the extent that:

(1) The authorization by the departmental licensed provider to impose involuntary treatment issued pursuant to Cor 303.02 shall last for not longer than 72 hours unless the licensed provider issues a new 72 hour authorization;

(2) No treatment shall be administered pursuant to Cor 303.02 which is not reasonably expected to alleviate or ameliorate the condition which has caused the need for said involuntary treatment; and

(3) The treatment that is administered shall be a form of treatment that is the least restrictive effective treatment.

(g) When any emergency treatment is administered pursuant to Cor 303.02 the physician, or advanced practice registered nurse (APRN) administering or directing such treatment shall record in the person under departmental control's health record the specific reasons that such involuntary treatment is necessary and the provider's emergency response shall be an intervention that:

(1) Is expected to be effective;

(2) Considers whether any of the following factors regarding the individual's condition would require special accommodation to ensure necessary communication and the individual's safety:

a. Medical factors;

b. Psychological factors; and

c. Physical factors, including:

i. Blindness or other limitations of sight;

ii. Deafness or other limitations of hearing; and

iii. Any other physical limitation that would require special accommodation;

(3) Is the least restrictive of the individual's freedom of movement; and

(4) Gives consideration to the individual's preferred response to a psychiatric emergency situation.

(h) Documentation pursuant to (g) above shall be distributed as follows:

(1) The original of the physician's, or APRN's note regarding the involuntary treatment shall be retained in the person under departmental control's medical health record; and

(2) A copy shall be promptly transmitted to the chief medical officer to keep him or her informed of persons under departmental control receiving treatment pursuant to Cor 303.02.

(i) A person under departmental control or legally responsible person may complain against and appeal the administration of involuntary treatment pursuant to Cor 303.02 in accordance with the departmental grievance procedure as outlined in the departmental handbooks. The commissioner shall act on the appeal within 48 hours after securing additional advice and expertise from healthcare professionals.

(j) Each instance of involuntary emergency treatment shall require an administrative review conducted by the director of medical and forensic services which shall review the treatment and circumstances and make recommendations to the commissioner.

(k) Departmental employees shall use the minimal amount of force and restraint necessary to prevent serious bodily harm to the persons under departmental control or others.

(l) All such interventions shall be limited to the extent that:

(1) Any such intervention shall be imposed for a period no longer than is necessary to resolve a personal safety emergency regardless of the length of the time identified in the order;

(2) Interventions emergently imposed by licensed nursing staff may not exceed one hour until a physician, or APRN can be consulted to determine if continued authorization of emergency treatment is necessary;

(3) Authorization for the use of seclusion or restraint shall be as follows:

a. Follows deliberate and comprehensive consultation between the physician and a trained advanced practice registered nurse (APRN) or registered nurse (RN) who has personally evaluated the individual by reviewing:

1. The assessments of the individual that have been performed;

2. The safety issues involved; and

3. The potential antecedents to the seclusion or restraint.

b. Trained nursing staff shall continually monitor the individual during periods of seclusion or restraint to ensure that:

1. In the judgment of the nursing staff, all reasonable measures are in place to ensure that the individual's health and safety is protected during the period of seclusion or restraint;

2. The individual receives meals and regular opportunities to move and to utilize the bathroom;

3. All other basic physiological needs are identified and met; and

4. The seclusion or restraint is discontinued as soon as the emergency is resolved, regardless of the length of time identified in the order; and

c. Include in the authorization order established release criteria for the termination of the seclusion or restraint.

(4) The physician, or APRN shall authorize the use of restraint or seclusion by telephone order for a period not to exceed 4 hours;

(5) Such authorization shall expire unless it is renewed by telephone order for an additional 4 hours;

(6) Any further extensions of restraint or seclusion shall require a personal examination or observation by a physician, or APRN;

(7) Individuals in seclusion or restraint shall be afforded privacy through practices including:

a. The use of a room designed for the purpose of seclusion or restraint;

b. Minimizing external stimuli such as noise, nearby movement, and approaches by other individuals; and

c. Continuous staff observation to assure the conditions in (2) above are met.

(8) Seclusion or restraint shall never be used explicitly or implicitly as punishment for the behavior of the individual; and

(9) Restraint or seclusion shall be used only as a last resort when no other intervention in an emergency situation is feasible to protect the immediate safety of the individual or others.

Notes

N.H. Admin. Code § Cor 303.02

(See Revision Note at chapter heading for Cor 300) #7448, eff 2-6-01; ss by #9383, INTERIM, eff 2-3-09, EXPIRES: 8-3-09; ss by #9508, eff 7-8-09

Amended by Volume XXXVII Number 41, Filed October 12, 2017, Proposed by #12396, Effective 9/29/2017, Expires 3/28/2018. Amended by Volume XXXVIII Number 15, Filed April 12, 2018, Proposed by #12502, Effective 3/23/2018, Expires 3/23/2028.