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Ann Marie T. Sullivan, M.D., Acting Commissioner
Governor Andrew M. Cuomo

Appendix 2: Revised QA-530
OMH Sample Agreement

Sample Agreement

Agreement between _________________________________________ Psychiatric Center, the __________________________________police department, and the _________________________________ County District Attorney, made this ______ day of ______________________, 20___.

WHEREAS, the Directors of State Psychiatric Centers, police, and district attorneys share an important and legitimate interest in protecting the safety of patients and employees, in assuring that serious crimes are appropriately prosecuted, and in avoiding criminal prosecution of patients for minor criminal offenses when clinical considerations outweigh law enforcement interests; and

WHEREAS, the Directors of State Psychiatric Centers are required, under Section 7.21(b) of the New York State Mental Hygiene Law, to notify local district attorneys or other appropriate law enforcement official when it appears that a crime may have occurred at the facility; and

WHEREAS, the Psychiatric Center is committed to protecting the privacy of its patients; and

WHEREAS federal regulations governing the privacy of individually identifiable health information permit disclosures where such disclosures are required by law, or when they are made to a law enforcement official if an entity subject to such regulations (i.e., "covered entity") believes in good faith that the information so disclosed constitutes evidence of criminal conduct that occurred on the premises of the covered entity (45 C.F.R.§164.512(a), (f)(5)), and the Office of Mental Health has determined that it is a covered entity in accordance with these regulations.

NOW, THEREFORE, the parties agree to the following:

  1. Serious incidents, particularly homicides, homicide attempts, aggravated assaults, sexual assaults, or other incidents which may involve criminal conduct and in which a serious injury is sustained will be immediately reported by telephone to local police. Local police will respond immediately. The scene of the incident will be preserved until their arrival. The police will determine the extent of their involvement in the investigation. The Psychiatric Center will cooperate with the police in every way possible.
  2. Assaults, sexual contact between patients who may be incompetent, and other incidents which may be crimes, but which do not involve serious injuries, will be reported by forwarding a copy of the incident report to the local police within 3 business days of the incident. These incidents will be fully investigated by the Psychiatric Center in accordance with Office of Mental Health Policy Directive QA-510, or its most recent iteration.
  3. The local police and district attorney will each establish confidential files of reports by the Psychiatric Center in which patients are identified. The identity of patients, and confidential information obtained about patients in the course of a police investigation, shall not be a public record and shall not be revealed. It is understood that records of criminal proceedings against patients may be public records.
  4. The local police, district attorney, and Psychiatric Centers have identified the following individuals who will act as liaison officers between them:
     
    Local Police:
    Name
    Telephone Number
    District Attorney:
    Name
    Telephone Number
    Psychiatric Center:
    Name
    Telephone Number
  5. The Psychiatric Center will sometimes suggest that clinical considerations warrant limiting police investigations or justify a decision against prosecution of an act which may be a crime. The Psychiatric Center will inform the local police and district attorney when such circumstances arise. As a general matter, in the absence of the use of physical force or coercion, the Psychiatric Center recommends against police investigation or prosecution for sexual contacts involving patients, even though one or both may be incompetent. Except when a patient is sociopathic, the Psychiatric Center will recommend against criminal prosecution of patients for simple assaults.
  6. Individual patients or employees of the Psychiatric Center may wish to file criminal complaints. In such cases, the individual will be given a form asking that he/she identify what happened, where, when, and who was involved. This information will be forwarded to the local police by the Psychiatric Center along with any report of the incident. The Psychiatric Center may also inform the local police if it is believed that a patient/complainant lacks capacity to make a sworn oath, if it appears to the facility that there is a lack of credible evidence to support the complaint, or there are clinical considerations which warrant discretion in investigating or prosecuting the complaint.

    The police or the warrant clerk of the local criminal court will prepare the criminal complaint and return it to the Safety Office of the Psychiatric Center. The Safety Office will then offer the patient or employee the opportunity to sign the complaint. If it is signed, it will be forwarded to the local police for further processing, and issuance of an arrest warrant. Nothing in this Agreement shall be construed to limit the right of a person to make a complaint directly to the police.

  7. Warrants for the arrest of any inpatient of the Psychiatric Center will be delivered to the facility Safety Office. In the event that a patient's clinical condition precludes an arrest or court appearance, the local police will be so informed. In such a case, service of the warrant on the patient will be deferred, arraignment on the charges deferred, or other action will be taken by the local police and district attorney to defer criminal proceedings. The Psychiatric Center will notify the local police and district attorney prior to discharging such a patient.
  8. Except in an emergency, the local police will be asked to check their weapons at the Psychiatric Center Safety Office before entering the patient care area. The weapons shall be kept under lock and key.
  9. The Psychiatric Center will inform the local police of escapes by patients considered likely to be violent, patients committed pursuant to Article 730 or 330 of the Criminal Procedure Law, the Family Court Act, or §517 of the Executive Law. Such disclosures are permissible under federal regulations as either disclosures required by law or disclosures necessary to prevent/lessen a serious and imminent threat to the health or safety of a person or the public (45 C.F.R. § 164.512(a),(j)).
  10. If the local police locate a missing patient, they will return the patient to the Admissions Office of the Psychiatric Center. The local police will remain at the Center for a sufficient period of time to inform the Psychiatric Center staff of the circumstances under which the patient was located.
  11. It is understood that the Psychiatric Center will be operating under the Office of Mental Health Policy Directives QA-510 Clinical Risk Management and Risk Management Plans; QA-515 Reporting Requirements for Alleged Child Abuse and Neglect; Qa-520 Missing Persons; QA-530 Reporting Requirements for Events Which May Be Crimes. Copies of these policy directives are attached.
  12. If staff of the Psychiatric Center, the local police, or the district attorney's office are dissatisfied with any aspect of their working relationship, the liaison officers will attempt to resolve the problem. When necessary, the facility director, police chief, or district attorney will be asked to help resolve a dispute.
  13. Signatures.
     
    Local Police:
     
    BY:
     
    County District Attorney:
     
    BY:
     
    Psychiatric Center:
     
    BY: