N.H. Admin. Code § Cor 502.07 - Involuntary Emergency Medical Treatment

(a) The department shall maintain the general health and well-being of residents. Resident's whose medical condition requires, in the opinion of the departmental physician, physician's assistant, or APRN, 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 resident, pursuant to RSA 627:6 (b), VII.

(b) In the case of an incompetent resident, pursuant to RSA 627:6, VII(b), emergency treatment shall be administered when the physician, physician's assistant. or APRN licensed provider reasonably believes that a reasonable person concerned for the welfare of the resident 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.

(c) 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.

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

(1) The authorization by the departmental licensed provider to impose involuntary treatment issued pursuant to Cor 502.07 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 502.07 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.

(e) When any emergency treatment is administered pursuant to Cor 502.07 the physician or APRN administering or directing such treatment shall record in the resident's health record the specific reasons that such involuntary treatment is necessary.

(f) 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 resident's condition would require special accommodation to ensure necessary communication and the resident's safety:

a. Medical factors;

b. Psychological factors; and

c. Physical factors, including:

1. Blindness or other limitations of sight;

2. Deafness or other limitations of hearing; and

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

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

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

(g) Documentation pursuant to (e) 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 resident's medical health record; and

(2) A copy shall be promptly transmitted to the psychiatric medical director or designee to keep him or her informed of residents receiving treatment pursuant to Cor 502.07.

(h) A resident or legally responsible person may complain against and appeal the administration of involuntary treatment pursuant to Cor 502.07 in accordance with the departmental grievance procedure pursuant to Cor 313. The commissioner shall act on the appeal within 48 hours after securing additional advice and expertise from healthcare professionals.

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

(j) Departmental employees shall use the minimal amount of force and restraint necessary to prevent serious bodily harm to the resident or others.

(k) 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; and

(3) Authorization for the use of seclusion or restraint shall be pursuant to Cor 502.07(f).

Notes

N.H. Admin. Code § Cor 502.07

Derived from Volume XXXIX Number 24, Filed June 13, 2019, Proposed by #12793, Effective 5/25/2019, Expires 5/25/2029.