EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted. Green numbers along left margin indicate location on the printed bill (e.g., 5-15 indicates page 5, line 15).

educational services in this state is entitled to a comprehensive treatment or

2-1 Section 1. Chapter 433 of NRS is hereby amended by adding thereto

2-2 the provisions set forth as sections 2 to 21, inclusive, of this act.

2-3 Sec. 2. As used in sections 2 to 21, inclusive, of this act, unless the

2-4 context otherwise requires, the words and terms defined in sections 3 to

2-5 13, inclusive, of this act have the meanings ascribed to them in those

2-6 sections.

2-7 Sec. 3. "Aversive intervention" means:

2-8 1. The use of noxious odors and tastes;

2-9 2. The use of water and other mists or sprays;

2-10 3. The use of blasts of air;

2-11 4. The use of corporal punishment;

2-12 5. The use of verbal and mental abuse;

2-13 6. The use of electric shock;

2-14 7. The placement of a person in seclusion;

2-15 8. Requiring a person to obtain or maintain a physically painful

2-16 position, excluding physical restraint;

2-17 9. Requiring a person to perform exercise under forced conditions;

2-18 10. Any intervention, technique or procedure that deprives a person

2-19 of the use of one or more of his senses, regardless of the length of the

2-20 deprivation;

2-21 11. The deprivation of necessities needed to sustain the health of a

2-22 person, regardless of the length of the deprivation; or

2-23 12. The use of time out in another room in an emergency.

2-24 Sec. 4. "Chemical restraint" means the administration of drugs for

2-25 the specific and exclusive purpose of controlling an acute or episodic

2-26 aggressive behavior when alternative intervention techniques have failed

2-27 to limit or control the behavior. The term does not include the

2-28 administration of drugs on a regular basis, as prescribed by a physician,

2-29 to treat the symptoms of mental, physical, emotional or behavioral

2-30 disorders and for assisting a person in gaining self-control over his

2-31 impulses.

2-32 Sec. 5. "Corporal punishment" means the intentional infliction of

2-33 physical pain, including, without limitation, hitting, pinching or striking.

2-34 Sec. 6. "Electric shock" means the application of electric current to

2-35 a person’s skin or body.

2-36 Sec. 7. "Emergency" means a situation in which immediate

2-37 intervention is necessary to protect the physical safety of a person or

2-38 others from an immediate threat of physical injury or to protect against

2-39 an immediate threat of severe property damage.

3-1 Sec. 8. "Exclusionary time out" means the removal of a person from

3-2 an ongoing activity to a location where the person cannot observe the

3-3 activity.

3-4 Sec. 9. "Mechanical restraint" means the use of devices, including,

3-5 without limitation, mittens, straps and restraint chairs to limit a person’s

3-6 movement or hold a person immobile.

3-7 Sec. 10. "Physical restraint" means the use of physical contact to

3-8 limit a person’s movement or hold a person immobile.

3-9 Sec. 11. "Seclusion" means the placement of a person alone in a

3-10 room where release from the room is prohibited by a mechanism,

3-11 including, without limitation, a lock, device or object positioned to hold

3-12 the door closed or otherwise prevent the person from leaving the room.

3-13 The term does not include exclusionary time out or time out in another

3-14 room.

3-15 Sec. 12. "Time out in another room" means the removal of a person

3-16 from an ongoing activity to an unlocked room where the door to the

3-17 room is held shut by another person or by a mechanism that requires the

3-18 constant physical pressure of another person to keep the mechanism

3-19 engaged. The term is equivalent to the term "time-out room" as referred

3-20 to in 42 C.F.R. § 483.450.

3-21 Sec. 13. "Verbal and mental abuse" means actions or utterances

3-22 that cause mental distress including, without limitation, the use of

3-23 obscene gestures and words to frighten, humiliate, intimidate, threaten or

3-24 insult.

3-25 Sec. 14. A person employed by a facility or any other person shall

3-26 not use any aversive intervention on a client.

3-27 Sec. 15. A person employed by a facility or any other person shall

3-28 not:

3-29 1. Except as otherwise provided in section 16 of this act, place a

3-30 client on exclusionary time out or time out in another room.

3-31 2. Except as otherwise provided in section 17 of this act, use physical

3-32 restraint on a client.

3-33 3. Except as otherwise provided in section 18 of this act, use

3-34 mechanical restraint on a client.

3-35 4. Except as otherwise provided in section 19 of this act, use

3-36 chemical restraint on a client.

3-37 Sec. 16. 1. A client may be placed on exclusionary time out or time

3-38 out in another room if:

3-39 (a) The use of the procedure is:

3-40 (1) Based upon a need identified in the client’s plan of care; and

3-41 (2) Included in the client’s plan of care, for which informed

3-42 consent has been obtained pursuant to NRS 433.484;

4-1 (b) The procedure is carried out in accordance with the client’s plan

4-2 of care;

4-3 (c) The procedure is the lowest level of intrusiveness required to

4-4 influence the behavior of the client and is not excessively intrusive in

4-5 relation to that behavior;

4-6 (d) The use of the procedure is supported by documentation in the

4-7 client’s record that indicates:

4-8 (1) Less intrusive procedures have been tried on the client but have

4-9 failed to change the inappropriate behavior of the client;

4-10 (2) The length of time the less intrusive procedures were used; and

4-11 (3) The possible reasons why the less intrusive procedures failed;

4-12 (e) The procedure is carried out and continuously monitored by

4-13 members of the staff of the facility who are qualified and trained in the

4-14 proper application of the procedure;

4-15 (f) The client is protected from hazardous conditions;

4-16 (g) Except as otherwise provided in paragraph (k), the release of the

4-17 client from time out is contingent upon whether the client stops or

4-18 controls the behavior that precipitated the use of time out;

4-19 (h) The staff who are responsible for monitoring the client attempt to

4-20 return the client to the activity from which he was removed at least every

4-21 30 minutes, regardless of whether the client stops or controls the

4-22 behavior that precipitated the use of time out;

4-23 (i) The client is offered access to a toilet and water at least every 30

4-24 minutes;

4-25 (j) The client is released from time out immediately if he stops or

4-26 controls the behavior that precipitated the time out and is returned to the

4-27 activity from which he was removed, if possible; and

4-28 (k) Placement of the client on time out does not exceed 60 consecutive

4-29 minutes after the initiation of the time out.

4-30 2. The facility shall maintain a record of each time that a client is

4-31 placed on time out.

4-32 Sec. 17. 1. Except as otherwise provided in subsection 2, physical

4-33 restraint may be used on a client only if:

4-34 (a) An emergency exists that necessitates the use of physical restraint;

4-35 (b) The physical restraint is used only for the period that is necessary

4-36 to contain the behavior of the client so that the client is no longer an

4-37 immediate threat to himself or others; and

4-38 (c) The use of force in the application of physical restraint does not

4-39 exceed the force that is reasonable and necessary under the

4-40 circumstances precipitating the use of physical restraint.

4-41 2. Physical restraint may be used on a client and the provisions of

4-42 subsection 1 do not apply if the physical restraint is used to:

5-1 (a) Assist the client in completing a task or response if the client does

5-2 not resist the application of physical restraint or if his resistance is

5-3 minimal in intensity and duration;

5-4 (b) Escort or carry a client to safety if the client is in danger in his

5-5 present location; or

5-6 (c) Conduct medical examinations or treatments on the client that are

5-7 necessary.

5-8 3. If physical restraint is used on a client in an emergency, the use of

5-9 the procedure must be reported as a denial of rights pursuant to NRS

5-10 433.534, regardless of whether the use of the procedure is authorized by

5-11 statute. The report must be made not later than 1 working day after the

5-12 procedure is used.

5-13 Sec. 18. 1. Except as otherwise provided in subsection 2,

5-14 mechanical restraint may be used on a client only if:

5-15 (a) An emergency exists that necessitates the use of mechanical

5-16 restraint;

5-17 (b) A medical order authorizing the use of mechanical restraint is

5-18 obtained from the client’s treating physician before the application of the

5-19 mechanical restraint or not later than 15 minutes after the application of

5-20 the mechanical restraint;

5-21 (c) The physician who signed the order required pursuant to

5-22 paragraph (b) examines the client on the working day immediately after

5-23 the application of the mechanical restraint;

5-24 (d) The mechanical restraint is applied by a member of the staff of the

5-25 facility who is trained and qualified to apply mechanical restraint;

5-26 (e) The client is released from the mechanical restraint to move and

5-27 exercise the parts of his body that are restrained at least 10 minutes per

5-28 every 60 minutes of restraint;

5-29 (f) A member of the staff of the facility lessens or discontinues the

5-30 restraint every 15 minutes to determine whether the client will stop or

5-31 control his inappropriate behavior without the use of the restraint;

5-32 (g) The record of the client contains a notation that includes the time

5-33 of day that the restraint was lessened or discontinued pursuant to

5-34 paragraph (f) and the response of the client; and

5-35 (h) The client is released from the mechanical restraint as soon as his

5-36 behavior no longer presents an immediate threat to himself or others.

5-37 2. Mechanical restraint may be used on a client and the provisions of

5-38 subsection 1 do not apply if the mechanical restraint is used to:

5-39 (a) Treat the medical needs of a client;

5-40 (b) Protect a client who is known to be at risk of injury to himself

5-41 because he lacks coordination or suffers from frequent loss of

5-42 consciousness; or

6-1 (c) Position a client who has physical disabilities in a manner

6-2 prescribed in the client’s plan of services.

6-3 3. If mechanical restraint is used on a client in an emergency, the

6-4 use of the procedure must be reported as a denial of rights pursuant to

6-5 NRS 433.534, regardless of whether the use of the procedure is

6-6 authorized by statute. The report must be made not later than 1 working

6-7 day after the procedure is used.

6-8 Sec. 19. 1. Chemical restraint may only be used on a client if:

6-9 (a) The client has been diagnosed as mentally ill, as defined in NRS

6-10 433A.115, and is receiving mental health services from a facility;

6-11 (b) Except as otherwise provided in subsection 4, the chemical

6-12 restraint is administered to the client while he is under the care of the

6-13 facility;

6-14 (c) An emergency exists that necessitates the use of chemical

6-15 restraint;

6-16 (d) A medical order authorizing the use of chemical restraint is

6-17 obtained from the client’s attending physician or psychiatrist or, if he is

6-18 unavailable, another licensed physician not later than 15 minutes after

6-19 the administration of the chemical restraint;

6-20 (e) The physician or psychiatrist who signed the order required

6-21 pursuant to paragraph (d) examines the client on the working day

6-22 immediately after the administration of the chemical restraint; and

6-23 (f) The chemical restraint is administered by a licensed physician or

6-24 registered nurse.

6-25 2. If chemical restraint is used on a client, the use of the procedure

6-26 must be reported as a denial of rights pursuant to NRS 433.534,

6-27 regardless of whether the use of the procedure is authorized by statute.

6-28 The report must be made not later than 1 working day after the

6-29 procedure is used.

6-30 3. If the client’s attending physician or psychiatrist did not sign the

6-31 order required pursuant to paragraph (d) of subsection 1, the licensed

6-32 physician who signed the order shall consult with and provide notice of

6-33 the administration of the chemical restraint to the client’s attending

6-34 physician or psychiatrist not later than 2 working days after the

6-35 procedure is used.

6-36 4. If a client is transported from a facility to an independent center

6-37 for emergency medical care, as defined in NRS 449.013, chemical

6-38 restraint may be administered to the client while he is under the care of

6-39 the center in accordance with the provisions of this section.

6-40 Sec. 20. 1. Each facility shall develop a program of education for

6-41 the members of the staff of the facility to provide instruction in positive

6-42 behavioral interventions and positive behavioral supports that:

7-1 (a) Includes positive methods to modify the environment of clients to

7-2 promote adaptive behavior and reduce the occurrence of inappropriate

7-3 behavior;

7-4 (b) Includes methods to teach skills to clients so that clients can

7-5 replace inappropriate behavior with adaptive behavior;

7-6 (c) Includes methods to enhance a client’s independence and quality

7-7 of life;

7-8 (d) Includes the use of the least intrusive methods to respond to and

7-9 reinforce the behavior of clients; and

7-10 (e) Offers a process for designing interventions based upon the client

7-11 that are focused on promoting appropriate changes in behavior as well as

7-12 enhancing the overall quality of life for the client.

7-13 2. Each facility shall provide appropriate training for the members of

7-14 the staff of the facility who are authorized to carry out and monitor

7-15 exclusionary time out, time out in another room, physical restraint,

7-16 mechanical restraint and chemical restraint to ensure that those

7-17 members of the staff are competent and qualified to carry out the

7-18 procedures in accordance with sections 2 to 21, inclusive, of this act.

7-19 Sec. 21. 1. A facility where a violation of the provisions of sections

7-20 2 to 21, inclusive, of this act occurs shall:

7-21 (a) Not later than 24 hours after a violation occurs, or as soon

7-22 thereafter as the violation is discovered, report the violation to the

7-23 division; and

7-24 (b) Develop, in cooperation with the division, a corrective plan to

7-25 ensure that within 30 calendar days after the violation occurred,

7-26 appropriate action is taken by the facility to prevent future violations.

7-27 2. The division shall forward the plan to the director of the

7-28 department. The director or his designee shall review the plan to ensure

7-29 that it complies with applicable federal law and the statutes and

7-30 regulations of this state. The director or his designee may require

7-31 appropriate revision of the plan to ensure compliance.

7-32 3. If the facility where the violation occurred does not meet the

7-33 requirements of the plan to the satisfaction of the director or his

7-34 designee, the department may withhold funding for the facility until the

7-35 facility meets the requirements of the plan.

7-36 Sec. 22. NRS 433.484 is hereby amended to read as follows:

7-37 433.484 Each client admitted for evaluation, treatment or training to a

7-43 training including prompt and appropriate medical treatment and care for

8-1 physical and mental ailments and for the prevention of any illness or

8-2 disability. All of that care, treatment and training must be consistent with

8-3 standards of practice of the respective professions in the community and is

8-4 subject to the following conditions:

8-5 (a) Before instituting a plan of care, treatment or training or carrying out

8-6 any necessary surgical procedure, express and informed consent must be

8-7 obtained in writing from:

8-8 (1) The client if he is 18 years of age or over or legally emancipated

8-9 and competent to give that consent, and from his legal guardian, if any;

8-10 (2) The parent or guardian of a client under 18 years of age and not

8-11 legally emancipated; or

8-12 (3) The legal guardian of a client of any age who has been

8-13 adjudicated mentally incompetent;

8-14 (b) An informed consent requires that the person whose consent is

8-15 sought be adequately informed as to:

8-16 (1) The nature and consequences of the procedure;

8-17 (2) The reasonable risks, benefits and purposes of the procedure; and

8-18 (3) Alternative procedures available;

8-19 (c) The consent of a client as provided in paragraph (b) may be

8-20 withdrawn by the client in writing at any time with or without cause;

8-21 (d) Even in the absence of express and informed consent, a licensed and

8-22 qualified physician may render emergency medical care or treatment to any

8-23 client who has been injured in an accident or who is suffering from an acute

8-24 illness, disease or condition, if within a reasonable degree of medical

8-25 certainty, delay in initiation of emergency medical care or treatment would

8-26 endanger the health of the client and if the treatment is immediately entered

8-27 into the client’s record of treatment, subject to the provisions of paragraph

8-28 (e); and

8-29 (e) If the proposed emergency medical care or treatment is deemed by

8-30 the chief medical officer of the facility to be unusual, experimental or

8-31 generally occurring infrequently in routine medical practice, the chief

8-32 medical officer shall request consultation from other physicians or

8-33 practitioners of healing arts who have knowledge of the proposed care or

8-34 treatment.

8-35 2. To be free from [the application of any mechanical restraint, except

8-36 if prescribed by a physician. If so prescribed, the restraint must be removed

8-37 whenever the condition justifying its use no longer exists, and any use of a

8-38 mechanical restraint, together with the reasons therefor, must be made a

8-39 part of the client’s record of treatment.] abuse, neglect and aversive

8-40 intervention.

8-41 3. To consent to his transfer from one facility to another, except that

8-42 the administrator of the mental hygiene and mental retardation division of

8-43 the department or his designee, or the administrator of the division of child

9-1 and family services of the department or his designee, may order a transfer

9-2 to be made whenever conditions concerning care, treatment or training

9-3 warrant it. If the client in any manner objects to the transfer, the person

9-4 ordering it must enter the objection and a written justification of the

9-5 transfer in the client’s record of treatment and immediately forward a notice

9-6 of the objection to the administrator who ordered the transfer, and the

9-7 commission shall review the transfer pursuant to subsection 3 of NRS

9-8 433.534.

9-9 4. Other rights concerning care, treatment and training as may be

9-10 specified by regulation of the commission.

9-11 Sec. 23. NRS 433.514 is hereby amended to read as follows:

9-12 433.514 1. [The] Except as otherwise provided in paragraph (d) of

9-18 nonprofessional personnel.

9-19 Sec. 24. NRS 433.554 is hereby amended to read as follows:

9-20 433.554 1. An employee of a public or private mental health facility

9-42 the client , [results,] is guilty of a category B felony . [and]

10-1 (c) For a second or subsequent violation, is guilty of a category B

10-2 felony.

10-3 A person convicted of a category B felony pursuant to this section shall

10-4 be punished by imprisonment in the state prison for a minimum term of not

10-5 less than 1 year and a maximum term of not more than 6 years, or by a fine

10-6 of not more than $5,000, or by both fine and imprisonment.

10-7 3. A person who is convicted pursuant to this section is ineligible for 5

10-8 years for appointment to or employment in a position in the state service

10-9 and, if he is an officer or employee of the state, he forfeits his office or

10-10 position.

10-11 4. A conviction pursuant to NRS 433.554 is, when applicable,

10-12 grounds for disciplinary action against the person so convicted and the

10-13 facility where the violation occurred. The division may recommend to the

10-14 appropriate agency or board the suspension or revocation of the

10-15 professional license, registration, certificate or permit of a person

10-16 convicted pursuant to NRS 433.554.

10-17 5. For the purposes of this section:

10-18 (a) "Abuse" means any willful and unjustified infliction of pain, injury

10-19 or mental anguish upon a client, including, but not limited to:

10-20 (1) The rape, sexual assault or sexual exploitation of the client;

10-21 (2) [Striking the client;

10-22 (3) Verbal intimidation or coercion of the client without a redeeming

10-23 purpose;

10-24 (4) The use of excessive force when placing the client in physical

10-25 restraints; and

10-26 (5)] The use of any type of aversive intervention;

10-27 (3) A violation of section 15 of this act; and

10-28 (4) The use of physical , [or] chemical or mechanical restraints or

10-29 the use of time out in another room in violation of [state or] federal
10-30 law.

10-31 Any act which meets the standard of practice for care and treatment does

10-32 not constitute abuse.

10-33 (b) "Client" includes any person who seeks, on his own or others’

10-34 initiative, and can benefit from care , treatment and training in a public or

10-35 private institution or facility offering mental health services. The term does

10-36 not include a client of the division of child and family services of the

10-37 department.

10-38 (c) "Neglect" means any omission to act which causes injury to a client

10-39 or which places the client at risk of injury, including, but not limited to, the

10-40 failure to follow:

10-41 (1) An appropriate plan of treatment to which the client has

10-42 consented; and

11-1 (2) The policies of the facility for the care and treatment of
11-2 clients.

11-3 Any omission to act which meets the standard of practice for care and

11-4 treatment does not constitute neglect.

11-5 (d) "Standard of practice" means the skill and care ordinarily exercised

11-6 by prudent professional personnel engaged in health care.

11-7 Sec. 25. NRS 435.350 is hereby amended to read as follows:

11-8 435.350 1. Each mentally retarded person admitted to a division

11-26 of denial of rights as are enumerated in subsection 3 of NRS 433.534.

11-27 Sec. 26. Chapter 388 of NRS is hereby amended by adding thereto the

11-28 provisions set forth as sections 27 to 50, inclusive, of this act.

11-29 Sec. 27. As used in sections 27 to 50, inclusive, of this act, unless the

11-30 context otherwise requires, the words and terms defined in sections 28 to

11-31 40, inclusive, of this act have the meanings ascribed to them in those

11-32 sections.

11-33 Sec. 28. "Aversive intervention" means:

11-34 1. The use of noxious odors and tastes;

11-35 2. The use of water and other mists or sprays;

11-36 3. The use of blasts of air;

11-37 4. The use of corporal punishment;

11-38 5. The use of verbal and mental abuse;

11-39 6. The use of electric shock;

11-40 7. The administration of chemical restraint to a person;

11-41 8. The placement of a person in seclusion;

11-42 9. Requiring a person to obtain or maintain a physically painful

11-43 position, excluding physical restraint;

12-1 10. Requiring a person to perform exercise under forced conditions;

12-2 11. Any intervention, technique or procedure that deprives a person

12-3 of the use of one or more of his senses, regardless of the length of the

12-4 deprivation;

12-5 12. The deprivation of necessities needed to sustain the health of a

12-6 person, regardless of the length of the deprivation; or

12-7 13. The use of time out in another room in an emergency.

12-8 Sec. 29. "Chemical restraint" means the administration of drugs for

12-9 the specific and exclusive purpose of controlling an acute or episodic

12-10 aggressive behavior when alternative intervention techniques have failed

12-11 to limit or control the behavior. The term does not include the

12-12 administration of drugs on a regular basis, as prescribed by a physician,

12-13 to treat the symptoms of mental, physical, emotional or behavioral

12-14 disorders and for assisting a person in gaining self-control over his

12-15 impulses.

12-16 Sec. 30. "Corporal punishment" means the intentional infliction of

12-17 physical pain, including, without limitation, hitting, pinching or striking.

12-18 Sec. 31. "Electric shock" means the application of electric current

12-19 to a person’s skin or body.

12-20 Sec. 32. "Emergency" means a situation in which immediate

12-21 intervention is necessary to protect the physical safety of a person or

12-22 others from an immediate threat of physical injury or to protect against

12-23 an immediate threat of severe property damage.

12-24 Sec. 33. "Exclusionary time out" means the removal of a person

12-25 from an ongoing activity to a location where the person cannot observe

12-26 the activity.

12-27 Sec. 34. "Individualized education program" has the meaning

12-28 ascribed to it in 20 U.S.C. § 1414(d)(1)(A).

12-29 Sec. 35. "Individualized education program team" has the meaning

12-30 ascribed to it in 20 U.S.C. § 1414(d)(1)(B).

12-31 Sec. 36. "Mechanical restraint" means the use of devices, including,

12-32 without limitation, mittens, straps and restraint chairs to limit a person’s

12-33 movement or hold a person immobile.

12-34 Sec. 37. "Physical restraint" means the use of physical contact to

12-35 limit a person’s movement or hold a person immobile.

12-36 Sec. 38. "Seclusion" means the placement of a person alone in a

12-37 room where release from the room is prohibited by a mechanism,

12-38 including, without limitation, a lock, device or object positioned to hold

12-39 the door closed or otherwise prevent the person from leaving the room.

12-40 The term does not include exclusionary time out or time out in another

12-41 room.

12-42 Sec. 39. "Time out in another room" means the removal of a person

12-43 from an ongoing activity to an unlocked room where the door to the

13-1 room is held shut by another person or by a mechanism that requires the

13-2 constant physical pressure of another person to keep the mechanism

13-3 engaged. The term is equivalent to the term "time-out room" as referred

13-4 to in 42 C.F.R. § 483.450.

13-5 Sec. 40. "Verbal and mental abuse" means actions or utterances

13-6 that cause mental distress including, without limitation, the use of

13-7 obscene gestures and words to frighten, humiliate, intimidate, threaten or

13-8 insult.

13-9 Sec. 41. A person employed by the board of trustees of a school

13-10 district or any other person shall not use any aversive intervention on a

13-11 pupil with a disability.

13-12 Sec. 42. A person employed by the board of trustees of a school

13-13 district or any other person shall not:

13-14 1. Except as otherwise provided in section 43 of this act, place a

13-15 pupil with a disability on exclusionary time out or time out in another

13-16 room.

13-17 2. Except as otherwise provided in section 44 of this act, use physical

13-18 restraint on a pupil with a disability.

13-19 3. Except as otherwise provided in section 45 of this act, use

13-20 mechanical restraint on a pupil with a disability.

13-21 Sec. 43. 1. A pupil with a disability may be placed on exclusionary

13-22 time out or time out in another room if:

13-23 (a) The use of the procedure is:

13-24 (1) Based upon a need identified in the pupil’s individualized

13-25 education program; and

13-26 (2) Included in the pupil’s individualized education program;

13-27 (b) Before the procedure is used, the parent or guardian of the pupil

13-28 provides his informed consent, as set forth in 34 C.F.R. § 300.500;

13-29 (c) The procedure is carried out in accordance with the pupil’s

13-30 individualized education program;

13-31 (d) The procedure is the lowest level of intrusiveness required to

13-32 influence the behavior of the pupil and is not excessively intrusive in

13-33 relation to that behavior;

13-34 (e) The use of the procedure is supported by documentation in the

13-35 pupil’s record that indicates:

13-36 (1) Less intrusive procedures have been tried on the pupil but have

13-37 failed to change the inappropriate behavior of the pupil;

13-38 (2) The length of time the less intrusive procedures were used; and

13-39 (3) The possible reasons why the less intrusive procedures failed;

13-40 (f) The procedure is carried out and continuously monitored by

13-41 members of the staff of the school who are qualified and trained in the

13-42 proper application of the procedure;

13-43 (g) The pupil is protected from hazardous conditions;

14-1 (h) Except as otherwise provided in paragraph (l), the release of the

14-2 pupil from time out is contingent upon whether the pupil stops or

14-3 controls the behavior that precipitated the use of time out;

14-4 (i) The staff who are responsible for monitoring the pupil attempt to

14-5 return the pupil to the activity from which he was removed at least every

14-6 30 minutes, regardless of whether the pupil stops or controls the behavior

14-7 that precipitated the use of time out;

14-8 (j) The pupil is offered access to a toilet and water at least every 30

14-9 minutes;

14-10 (k) The pupil is released from time out immediately if he stops or

14-11 controls the behavior that precipitated the time out and is returned to the

14-12 activity from which he was removed, if possible; and

14-13 (l) Placement of the pupil on time out does not exceed 60 consecutive

14-14 minutes after the initiation of the time out.

14-15 2. A school shall maintain a record of each time that a pupil with a

14-16 disability is placed on time out.

14-17 Sec. 44. 1. Except as otherwise provided in subsection 2, physical

14-18 restraint may be used on a pupil with a disability only if:

14-19 (a) An emergency exists that necessitates the use of physical restraint;

14-20 (b) The physical restraint is used only for the period time that is

14-21 necessary to contain the behavior of the pupil so that the pupil is no

14-22 longer an immediate threat to himself or others; and

14-23 (c) The use of force in the application of physical restraint does not

14-24 exceed the force that is reasonable and necessary under the

14-25 circumstances precipitating the use of physical restraint.

14-26 2. Physical restraint may be used on a pupil with a disability and the

14-27 provisions of subsection 1 do not apply if the physical restraint is used to:

14-28 (a) Assist the pupil in completing a task or response if the pupil does

14-29 not resist the application of physical restraint or if his resistance is

14-30 minimal in intensity and duration;

14-31 (b) Escort or carry a pupil to safety if the pupil is in danger in his

14-32 present location; or

14-33 (c) Conduct medical examinations or treatments on the pupil that are

14-34 necessary.

14-35 3. If physical restraint is used on a pupil with a disability in an

14-36 emergency, the use of the procedure must be reported in the pupil’s

14-37 cumulative record and a confidential file maintained for the pupil not

14-38 later than 1 working day after the procedure is used. A copy of the report

14-39 must be provided to the board of trustees of the school district, the pupil’s

14-40 individualized education program team and the parent or guardian of the

14-41 pupil. If the board of trustees determines that a denial of the pupil’s

14-42 rights has occurred, the board of trustees may submit a report to the

14-43 department in accordance with section 50 of this act.

15-1 Sec. 45. 1. Except as otherwise provided in subsection 2,

15-2 mechanical restraint may be used on a pupil with a disability only if:

15-3 (a) An emergency exists that necessitates the use of mechanical

15-4 restraint;

15-5 (b) A medical order authorizing the use of mechanical restraint is

15-6 obtained from the pupil’s treating physician before the application of the

15-7 mechanical restraint or not later than 15 minutes after the application of

15-8 the mechanical restraint;

15-9 (c) The physician who signed the order required pursuant to

15-10 paragraph (b) examines the pupil on the working day immediately after

15-11 the application of the mechanical restraint;

15-12 (d) The mechanical restraint is applied by a member of the staff of the

15-13 school who is trained and qualified to apply mechanical restraint;

15-14 (e) The pupil is released from the mechanical restraint to move and

15-15 exercise the parts of his body that are restrained at least 10 minutes per

15-16 every 60 minutes of restraint;

15-17 (f) A member of the staff of the school lessens or discontinues the

15-18 restraint every 15 minutes to determine whether the pupil will stop or

15-19 control his inappropriate behavior without the use of the restraint;

15-20 (g) The record of the pupil contains a notation that includes the time

15-21 of day that the restraint was lessened or discontinued pursuant to

15-22 paragraph (f) and the response of the pupil; and

15-23 (h) The pupil is released from the mechanical restraint as soon as his

15-24 behavior no longer presents an immediate threat to himself or others.

15-25 2. Mechanical restraint may be used on a pupil with a disability and

15-26 the provisions of subsection 1 do not apply if the mechanical restraint is

15-27 used to:

15-28 (a) Treat the medical needs of the pupil;

15-29 (b) Protect a pupil who is known to be at risk of injury to himself

15-30 because he lacks coordination or suffers from frequent loss of

15-31 consciousness; or

15-32 (c) Position a pupil who has physical disabilities in a manner

15-33 prescribed in the pupil’s individualized education program.

15-34 3. If mechanical restraint is used on a pupil with a disability in an

15-35 emergency, the use of the procedure must be reported in the pupil’s

15-36 cumulative record and a confidential file maintained for the pupil not

15-37 later than 1 working day after the procedure is used. A copy of the report

15-38 must be provided to the board of trustees of the school district, the pupil’s

15-39 individualized education program team and the parent or guardian of the

15-40 pupil. If the board of trustees determines that a denial of the pupil’s

15-41 rights has occurred, the board of trustees may submit a report to the

15-42 department in accordance with section 50 of this act.

16-1 Sec. 46. 1. The board of trustees of each school district shall

16-2 develop a program of education for the members of the staff of the

16-3 schools within the school district who provide services to pupils with

16-4 disabilities. The program of education must provide instruction in

16-5 positive behavioral interventions and positive behavioral supports that:

16-6 (a) Includes positive methods to modify the environment of pupils

16-7 with disabilities to promote adaptive behavior and reduce the occurrence

16-8 of inappropriate behavior;

16-9 (b) Includes methods to teach skills to pupils with disabilities so that

16-10 the pupils can replace inappropriate behavior with adaptive behavior;

16-11 (c) Includes methods to enhance the independence and quality of life

16-12 for pupils with disabilities;

16-13 (d) Includes the use of the least intrusive methods to respond to and

16-14 reinforce the behavior of pupils with disabilities; and

16-15 (e) Offers a process for designing interventions based upon the pupil

16-16 that are focused on promoting appropriate changes in behavior as well as

16-17 enhancing the overall quality of life for the pupil.

16-18 2. The board of trustees of each school district shall provide

16-19 appropriate training for the members of the staff of the schools within

16-20 the school district who are authorized to carry out and monitor

16-21 exclusionary time out, time out in another room, physical restraint and

16-22 mechanical restraint to ensure that those members of the staff are

16-23 competent and qualified to carry out the procedures in accordance with

16-24 sections 27 to 50, inclusive, of this act.

16-25 Sec. 47. 1. Unless a more severe penalty is prescribed by specific

16-26 statute, a person who willfully uses aversive intervention on a pupil with

16-27 a disability or violates section 42 of this act:

16-28 (a) For a first violation that does not result in substantial bodily harm

16-29 to the pupil, is guilty of a gross misdemeanor.

16-30 (b) For a first violation that results in substantial bodily harm to the

16-31 pupil, is guilty of a category B felony.

16-32 (c) For a second or subsequent violation, is guilty of a category B

16-33 felony.

16-34 A person who is convicted of a category B felony pursuant to this section

16-35 shall be punished by imprisonment in the state prison for a minimum

16-36 term of not less than 1 year and a maximum term of not more than 6

16-37 years, or by a fine of not more than $5,000, or by both fine and

16-38 imprisonment.

16-39 2. A person who is convicted pursuant to this section is ineligible for

16-40 5 years for employment with the board of trustees of a school district.

16-41 3. A conviction pursuant to this section is grounds for disciplinary

16-42 action against the person so convicted and the school district where the

16-43 violation occurred. The superintendent of schools of the school district

17-1 may recommend to the superintendent of public instruction the

17-2 suspension or revocation of the professional license, registration,

17-3 certificate or permit of a person convicted.

17-4 Sec. 48. 1. A school where a violation of sections 27 to 50,

17-5 inclusive, of this act occurs shall report the violation to the board of

17-6 trustees of the school district not later than 24 hours after the violation

17-7 occurred, or as soon thereafter as the violation is discovered.

17-8 2. The board of trustees of the school district where the violation

17-9 occurred shall develop, in cooperation with the superintendent of public

17-10 instruction, a corrective plan to ensure that within 30 calendar days after

17-11 the violation occurred, appropriate action is taken by the school and the

17-12 board of trustees to prevent future violations.

17-13 3. The superintendent of public instruction shall submit the plan to

17-14 the department. The department shall review the plan to ensure that it

17-15 complies with applicable federal law and the statutes and regulations of

17-16 this state. The department may require appropriate revision of the plan to

17-17 ensure compliance.

17-18 4. If the school where the violation occurred does not meet the

17-19 requirements of the plan to the satisfaction of the department, the

17-20 department may appoint an administrator to oversee the school to ensure

17-21 that the school meets the requirements of the plan.

17-22 Sec. 49. An officer, administrator or employee of a public school

17-23 shall not retaliate against any person for having:

17-24 1. Reported a violation of sections 27 to 50, inclusive, of this act; or

17-25 2. Provided information regarding a violation of sections 27 to 50,

17-26 inclusive, of this act,

17-27 by a public school or a member of the staff of the public school.

17-28 Sec. 50. 1. A denial of rights of a pupil with a disability pursuant

17-29 to sections 27 to 50, inclusive, of this act must be entered in the pupil’s

17-30 cumulative record and a confidential file maintained for that pupil.

17-31 Notice of the denial must be provided to the board of trustees of the

17-32 school district.

17-33 2. If the board of trustees of a school district receives notice of a

17-34 denial of rights pursuant to subsection 1, it shall cause a full report to be

17-35 prepared which must set forth in detail the factual circumstances

17-36 surrounding the denial. A copy of the report must be provided to the

17-37 department.

17-38 3. The department:

17-39 (a) Shall receive reports made pursuant to subsection 2;

17-40 (b) May investigate apparent violations of the rights of pupils with

17-41 disabilities; and

17-42 (c) May act to resolve disputes relating to apparent violations.

18-1 Sec. 51. NRS 388.440 is hereby amended to read as follows:

18-2 388.440 As used in NRS 388.440 to 388.520, inclusive [:] , and

18-12 services.

18-13 Sec. 52. NRS 391.100 is hereby amended to read as follows:

18-14 391.100 1. The board of trustees of a school district may employ a

18-34 persons to serve as school police officers.

18-35 Sec. 53. NRS 391.314 is hereby amended to read as follows:

18-36 391.314 1. If a superintendent has reason to believe that cause exists

18-43 involving moral turpitude or immorality. If the charge is dismissed or if the

19-1 employee is found not guilty, he must be reinstated with back pay, plus

19-2 interest, and normal seniority. The superintendent shall notify the employee

19-3 in writing of the suspension.

19-4 2. Within 5 days after a suspension becomes effective, the

19-5 superintendent shall begin proceedings pursuant to the provisions of NRS

19-6 391.312 to 391.3196, inclusive, to effect the employee’s dismissal. The

19-7 employee is entitled to continue to receive his salary and other benefits

19-8 after the suspension becomes effective until the date on which the dismissal

19-9 proceedings are commenced. The superintendent may recommend that an

19-10 employee who has been charged with a felony or a crime involving

19-11 immorality be dismissed for another ground set forth in NRS 391.312.

19-12 3. If sufficient grounds for dismissal do not exist, the employee must

19-13 be reinstated with full compensation, plus interest.

19-14 4. A licensed employee who furnishes to the school district a bond or

19-15 other security which is acceptable to the board as a guarantee that he will

19-16 repay any amounts paid to him pursuant to this subsection as salary during

19-17 a period of suspension is entitled to continue to receive his salary from the

19-18 date on which the dismissal proceedings are commenced until the decision

19-19 of the board or the report of the hearing officer, if the report is final and

19-20 binding. The board shall not unreasonably refuse to accept security other

19-21 than a bond. An employee who receives salary pursuant to this subsection

19-22 shall repay it if he is dismissed or not reemployed as a result of a decision

19-23 of the board or a report of a hearing officer.

19-24 5. A licensed employee who is convicted of a crime which requires

19-25 registration pursuant to NRS 179D.200 to 179D.290, inclusive, or

19-26 179D.350 to 179D.550, inclusive, or is convicted of an act forbidden by

19-27 NRS 200.508, 201.190 or 201.265 forfeits all rights of employment from

19-28 the date of his arrest.

19-29 6. A licensed employee who is convicted of any crime and who is

19-30 sentenced to and serves any sentence of imprisonment forfeits all rights of

19-31 employment from the date of his arrest or the date on which his

19-32 employment terminated, whichever is later. A licensed employee who is

19-33 convicted pursuant to section 47 of this act forfeits all rights of

19-34 employment from the date of his arrest or the date on which his

19-35 employment terminated, whichever is later.

19-36 7. A licensed employee who is charged with a felony or a crime

19-37 involving immorality or moral turpitude and who waives his right to a

19-38 speedy trial while suspended may receive no more than 12 months of back

19-39 pay and seniority upon reinstatement if he is found not guilty or the charges

19-40 are dismissed, unless proceedings have been begun to dismiss the employee

19-41 upon one of the other grounds set forth in NRS 391.312.

19-42 8. A superintendent may discipline a licensed employee by suspending

19-43 the employee with loss of pay at any time after a hearing has been held

20-1 which affords the due process provided for in this chapter. The grounds for

20-2 suspension are the same as the grounds contained in NRS 391.312. An

20-3 employee may be suspended more than once during the employee’s

20-4 contract year, but the total number of days of suspension may not exceed

20-5 20 in 1 contract year. Unless circumstances require otherwise, the

20-6 suspensions must be progressively longer.

20-7 Sec. 54. Chapter 394 of NRS is hereby amended by adding thereto the

20-8 provisions set forth as sections 55 to 79, inclusive, of this act.

20-9 Sec. 55. As used in sections 55 to 79, inclusive, of this act, unless the

20-10 context otherwise requires, the words and terms defined in sections 56 to

20-11 69, inclusive, of this act have the meanings ascribed to them in those

20-12 sections.

20-13 Sec. 56. "Aversive intervention" means:

20-14 1. The use of noxious odors and tastes;

20-15 2. The use of water and other mists or sprays;

20-16 3. The use of blasts of air;

20-17 4. The use of corporal punishment;

20-18 5. The use of verbal and mental abuse;

20-19 6. The use of electric shock;

20-20 7. The administration of chemical restraint to a person;

20-21 8. The placement of a person in seclusion;

20-22 9. Requiring a person to obtain or maintain a physically painful

20-23 position, excluding physical restraint;

20-24 10. Requiring a person to perform exercise under forced conditions;

20-25 11. Any intervention, technique or procedure that deprives a person

20-26 of the use of one or more of his senses, regardless of the length of the

20-27 deprivation;

20-28 12. The deprivation of necessities needed to sustain the health of a

20-29 person, regardless of the length of the deprivation; or

20-30 13. The use of time out in another room in an emergency.

20-31 Sec. 57. "Chemical restraint" means the administration of drugs for

20-32 the specific and exclusive purpose of controlling an acute or episodic

20-33 aggressive behavior when alternative intervention techniques have failed

20-34 to limit or control the behavior. The term does not include the

20-35 administration of drugs on a regular basis, as prescribed by a physician,

20-36 to treat the symptoms of mental, physical, emotional or behavioral

20-37 disorders and for assisting a person in gaining self-control over his

20-38 impulses.

20-39 Sec. 58. "Corporal punishment" means the intentional infliction of

20-40 physical pain, including, without limitation, hitting, pinching or striking.

20-41 Sec. 59. "Electric shock" means the application of electric current

20-42 to a person’s skin or body.

21-1 Sec. 60. "Emergency" means a situation in which immediate

21-2 intervention is necessary to protect the physical safety of a person or

21-3 others from an immediate threat of physical injury or to protect against

21-4 an immediate threat of severe property damage.

21-5 Sec. 61. "Exclusionary time out" means the removal of a person

21-6 from an ongoing activity to a location where the person cannot observe

21-7 the activity.

21-8 Sec. 62. "Individualized education program" has the meaning

21-9 ascribed to it in 20 U.S.C. § 1414(d)(1)(A).

21-10 Sec. 63. "Individualized education program team" has the meaning

21-11 ascribed to it in 20 U.S.C. § 1414(d)(1)(B).

21-12 Sec. 64. "Mechanical restraint" means the use of devices, including,

21-13 without limitation, mittens, straps and restraint chairs to limit a person’s

21-14 movement or hold a person immobile.

21-15 Sec. 65. "Physical restraint" means the use of physical contact to

21-16 limit a person’s movement or hold a person immobile.

21-17 Sec. 66. "Pupil with a disability" has the meaning ascribed to it in

21-18 NRS 388.440.

21-19 Sec. 67. "Seclusion" means the placement of a person alone in a

21-20 room where release from the room is prohibited by a mechanism,

21-21 including, without limitation, a lock, device or object positioned to hold

21-22 the door closed or otherwise prevent the person from leaving the room.

21-23 The term does not include exclusionary time out or time out in another

21-24 room.

21-25 Sec. 68. "Time out in another room" means the removal of a person

21-26 from an ongoing activity to an unlocked room where the door to the

21-27 room is held shut by another person or by a mechanism that requires the

21-28 constant physical pressure of another person to keep the mechanism

21-29 engaged. The term is equivalent to the term "time-out room" as referred

21-30 to in 42 C.F.R. § 483.450.

21-31 Sec. 69. "Verbal and mental abuse" means actions or utterances

21-32 that cause mental distress including, without limitation, the use of

21-33 obscene gestures and words to frighten, humiliate, intimidate, threaten or

21-34 insult.

21-35 Sec. 70. A person employed by a private school or any other person

21-36 shall not use any aversive intervention on a pupil with a disability.

21-37 Sec. 71. A person employed by a private school or any other person

21-38 shall not:

21-39 1. Except as otherwise provided in section 72 of this act, place a

21-40 pupil with a disability on exclusionary time out or time out in another

21-41 room.

21-42 2. Except as otherwise provided in section 73 of this act, use physical

21-43 restraint on a pupil with a disability.

22-1 3. Except as otherwise provided in section 74 of this act, use

22-2 mechanical restraint on a pupil with a disability.

22-3 Sec. 72. 1. A pupil with a disability may be placed on exclusionary

22-4 time out or time out in another room if:

22-5 (a) The use of the procedure is:

22-6 (1) Based upon a need identified in the pupil’s service plan

22-7 developed pursuant to 34 C.F.R. § 300.455 or the pupil’s individualized

22-8 education program, whichever is appropriate; and

22-9 (2) Included in the pupil’s service plan developed pursuant to 34

22-10 C.F.R. § 300.455 or the pupil’s individualized education program,

22-11 whichever is appropriate;

22-12 (b) Before the procedure is used, the parent or guardian of the pupil

22-13 provides his informed consent, as set forth in 34 C.F.R. § 300.500;

22-14 (c) The procedure is carried out in accordance with the pupil’s service

22-15 plan developed pursuant to 34 C.F.R. § 300.455 or the pupil’s

22-16 individualized education program, whichever is appropriate;

22-17 (d) The procedure is the lowest level of intrusiveness required to

22-18 influence the behavior of the pupil and is not excessively intrusive in

22-19 relation to that behavior;

22-20 (e) The use of the procedure is supported by documentation in the

22-21 pupil’s record that indicates:

22-22 (1) Less intrusive procedures have been tried on the pupil but have

22-23 failed to change the inappropriate behavior of the pupil;

22-24 (2) The length of time the less intrusive procedures were used; and

22-25 (3) The possible reasons why the less intrusive procedures failed;

22-26 (f) The procedure is carried out and continuously monitored by

22-27 members of the staff of the private school who are qualified and trained

22-28 in the proper application of the procedure;

22-29 (g) The pupil is protected from hazardous conditions;

22-30 (h) Except as otherwise provided in paragraph (l), the release of the

22-31 pupil from time out is contingent upon whether the pupil stops or

22-32 controls the behavior that precipitated the use of time out;

22-33 (i) The staff who are responsible for monitoring the pupil attempt to

22-34 return the pupil to the activity from which he was removed at least every

22-35 30 minutes, regardless of whether the pupil stops or controls the behavior

22-36 that precipitated the use of time out;

22-37 (j) The pupil is offered access to a toilet and water at least every 30

22-38 minutes;

22-39 (k) The pupil is released from time out immediately if he stops or

22-40 controls the behavior that precipitated the time out and is returned to the

22-41 activity from which he was removed, if possible; and

22-42 (l) Placement of the pupil on time out does not exceed 60 consecutive

22-43 minutes after the initiation of the time out.

23-1 2. The private school shall maintain a record of each time that a

23-2 pupil with a disability is placed on time out.

23-3 Sec. 73. 1. Except as otherwise provided in subsection 2, physical

23-4 restraint may be used on a pupil with a disability only if:

23-5 (a) An emergency exists that necessitates the use of physical restraint;

23-6 (b) The physical restraint is used only for the period that is necessary

23-7 to contain the behavior of the pupil so that the pupil is no longer an

23-8 immediate threat to himself or others; and

23-9 (c) The use of force in the application of physical restraint does not

23-10 exceed the force that is reasonable and necessary under the

23-11 circumstances precipitating the use of physical restraint.

23-12 2. Physical restraint may be used on a pupil with a disability and the

23-13 provisions of subsection 1 do not apply if the physical restraint is used to:

23-14 (a) Assist the pupil in completing a task or response if the pupil does

23-15 not resist the application of physical restraint or if his resistance is

23-16 minimal in intensity and duration;

23-17 (b) Escort or carry a pupil to safety if the pupil is in danger in his

23-18 present location; or

23-19 (c) Conduct medical examinations or treatments on the pupil that are

23-20 necessary.

23-21 3. If physical restraint is used on a pupil with a disability in an

23-22 emergency, the use of the procedure must be reported in the pupil’s

23-23 cumulative record not later than 1 working day after the procedure is

23-24 used. A copy of the report must be provided to the superintendent, the

23-25 pupil’s individualized education program team, if applicable, and the

23-26 parent or guardian of the pupil.

23-27 Sec. 74. 1. Except as otherwise provided in subsection 2,

23-28 mechanical restraint may be used on a pupil with a disability only if:

23-29 (a) An emergency exists that necessitates the use of mechanical

23-30 restraint;

23-31 (b) A medical order authorizing the use of mechanical restraint is

23-32 obtained from the pupil’s treating physician before the application of the

23-33 mechanical restraint or not later than 15 minutes after the application of

23-34 the mechanical restraint;

23-35 (c) The physician who signed the order required pursuant to

23-36 paragraph (b) examines the pupil on the working day immediately after

23-37 the application of the mechanical restraint;

23-38 (d) The mechanical restraint is applied by a member of the staff of the

23-39 private school who is trained and qualified to apply mechanical restraint;

23-40 (e) The pupil is released from the mechanical restraint to move and

23-41 exercise the parts of his body that are restrained at least 10 minutes per

23-42 every 60 minutes of restraint;

24-1 (f) A member of the staff of the private school lessens or discontinues

24-2 the restraint every 15 minutes to determine whether the pupil will stop or

24-3 control his inappropriate behavior without the use of the restraint;

24-4 (g) The record of the pupil contains a notation that includes the time

24-5 of day that the restraint was lessened or discontinued pursuant to

24-6 paragraph (f) and the response of the pupil; and

24-7 (h) The pupil is released from the mechanical restraint as soon as his

24-8 behavior no longer presents an immediate threat to himself or others.

24-9 2. Mechanical restraint may be used on a pupil with a disability and

24-10 the provisions of subsection 1 do not apply if the mechanical restraint is

24-11 used to:

24-12 (a) Treat the medical needs of the pupil;

24-13 (b) Protect a pupil who is known to be at risk of injury to himself