1.1                          A bill for an act 
  1.2             relating to health; allowing a nursing home resident 
  1.3             to request and consent to the use of a physical 
  1.4             restraint; requiring certain actions by the 
  1.5             commissioner of health with respect to immediate 
  1.6             jeopardy citations; amending Minnesota Statutes 1998, 
  1.7             sections 144.651, by adding a subdivision; and 
  1.8             144A.10, by adding a subdivision. 
  1.9   BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.10     Section 1.  Minnesota Statutes 1998, section 144.651, is 
  1.11  amended by adding a subdivision to read: 
  1.12     Subd. 33.  [RESTRAINTS.] (a) Competent nursing home 
  1.13  residents, family members of residents who are not competent, 
  1.14  and legally appointed conservators, guardians, and health care 
  1.15  agents as defined under section 145C.01, have the right to 
  1.16  request and consent to the use of a physical restraint in order 
  1.17  to treat the medical symptoms of the resident. 
  1.18     (b) Upon receiving a request for a physical restraint, a 
  1.19  nursing home shall inform the resident, family member, or legal 
  1.20  representative of alternatives to and the risks involved with 
  1.21  physical restraint use.  The nursing home shall provide a 
  1.22  physical restraint to a resident only upon receipt of a signed 
  1.23  consent form authorizing restraint use and a written order from 
  1.24  the attending physician that contains statements and 
  1.25  determinations regarding medical symptoms and specifies the 
  1.26  circumstances under which restraints are to be used. 
  1.27     (c) A nursing home providing a restraint under paragraph 
  2.1   (b) must: 
  2.2      (1) document that the procedures outlined in that paragraph 
  2.3   have been followed; 
  2.4      (2) monitor the use of the restraint by the resident; and 
  2.5      (3) periodically, in consultation with the resident, the 
  2.6   family, and the attending physician, reevaluate the resident's 
  2.7   need for the restraint. 
  2.8      (d) A nursing home shall not be subject to fines, civil 
  2.9   money penalties, or other state or federal survey enforcement 
  2.10  remedies solely as the result of allowing the use of a physical 
  2.11  restraint as authorized in this subdivision.  Nothing in this 
  2.12  subdivision shall preclude the commissioner from taking action 
  2.13  to protect the health and safety of a resident if: 
  2.14     (1) the use of the restraint has jeopardized the health and 
  2.15  safety of the resident; and 
  2.16     (2) the nursing home failed to take reasonable measures to 
  2.17  protect the health and safety of the resident. 
  2.18     (e) For purposes of this subdivision, "medical symptoms" 
  2.19  include: 
  2.20     (1) a concern for the physical safety of the resident; and 
  2.21     (2) physical or psychological needs expressed by a 
  2.22  resident.  A resident's fear of falling may be the basis of a 
  2.23  medical symptom. 
  2.24  A written order from the attending physician that contains 
  2.25  statements and determinations regarding medical symptoms is 
  2.26  sufficient evidence of the medical necessity of the physical 
  2.27  restraint. 
  2.28     (f) When determining nursing facility compliance with state 
  2.29  and federal standards for the use of physical restraints, the 
  2.30  commissioner of health is bound by the statements and 
  2.31  determinations contained in the attending physician's order 
  2.32  regarding medical symptoms.  For purposes of this order, 
  2.33  "medical symptoms" include the request by a competent resident, 
  2.34  family member of a resident who is not competent, or legally 
  2.35  appointed conservator, guardian, or health care agent as defined 
  2.36  under section 145C.01, that the facility provide a physical 
  3.1   restraint in order to enhance the physical safety of the 
  3.2   resident. 
  3.3      Sec. 2.  Minnesota Statutes 1998, section 144A.10, is 
  3.4   amended by adding a subdivision to read: 
  3.5      Subd. 11.  [FACILITIES CITED FOR IMMEDIATE JEOPARDY.] (a) 
  3.6   The provisions of this subdivision apply to Minnesota nursing 
  3.7   facilities: 
  3.8      (1) that received immediate jeopardy citations between 
  3.9   April 1, 1998, and January 13, 1999, for violations of 
  3.10  regulations governing the use of physical restraints; and 
  3.11     (2) on whose behalf the commissioner recommended to the 
  3.12  federal government that fines for these citations not be imposed 
  3.13  or be rescinded.  
  3.14     (b) The commissioner: 
  3.15     (1) shall grant all possible waivers for the continuation 
  3.16  of an approved nurse aide training program, an approved 
  3.17  competency evaluation program, or an approved nurse aide 
  3.18  training and competency evaluation program conducted by or on 
  3.19  the site of a facility referred to in this subdivision; and 
  3.20     (2) shall notify the board of nursing home administrators 
  3.21  by June 1, 1999, that the commissioner has recommended to the 
  3.22  federal government that fines not be imposed on the facilities 
  3.23  referred to in this subdivision or that any fines imposed on 
  3.24  these facilities for violations of regulations governing use of 
  3.25  physical restraints be rescinded. 
  3.26     Sec. 3.  [EFFECTIVE DATE.] 
  3.27     Sections 1 and 2 are effective the day following final 
  3.28  enactment.