Federal Register / Vol. 75, No. 220 / Tuesday, November 16, 2010 / Rules and Regulations 69883 

Dated: November 9, 2010. 

Robert C. McFetridge, 

Director of Regulation Policy and 

Management, Office of the General Counsel. 

■ For the reasons stated in the preamble, 

the Department of Veterans Affairs 

amends 38 CFR part 17 as follows: 

PART 17—MEDICAL 

■ 1. Revise the authority citation for part 

17 to read as follows: 

Authority: 38 U.S.C. 501, and as noted in 

specific sections. 

■ 2. Revise § 17.106 to read as follows: 

§ 17.106 VA response to disruptive 

behavior of patients. 

(a) Definition. For the purposes of this 

section: 

VA medical facility means VA 

medical centers, outpatient clinics, and 

domiciliaries. 

(b) Response to disruptive patients. 

The time, place, and/or manner of the 

provision of a patient’s medical care 

may be restricted by written order of the 

Chief of Staff of the VA Medical Center 

of jurisdiction or his or her designee if: 

(1) The Chief of Staff or designee 

determines pursuant to paragraph (c) of 

this section that the patient’s behavior at 

a VA medical facility has jeopardized or 

could jeopardize the health or safety of 

other patients, VA staff, or guests at the 

facility, or otherwise interfere with the 

delivery of safe medical care to another 

patient at the facility; 

(2) The order is narrowly tailored to 

address the patient’s disruptive 

behavior and avoid undue interference 

with the patient’s care; 

(3) The order is signed by the Chief of 

Staff or designee, and a copy is entered 

into the patient’s permanent medical 

record; 

(4) The patient receives a copy of the 

order and written notice of the 

procedure for appealing the order to the 

Network Director of jurisdiction as soon 

as possible after issuance; and 

(5) The order contains an effective 

date and any appropriate limits on the 

duration of or conditions for continuing 

the restrictions. The Chief of Staff or 

designee may order restrictions for a 

definite period or until the conditions 

for removing conditions specified in the 

order are satisfied. Unless otherwise 

stated, the restrictions imposed by an 

order will take effect upon issuance by 

the Chief of Staff or designee. Any order 

issued by the Chief of Staff or designee 

shall include a summary of the 

pertinent facts and the bases for the 

Chief of Staff’s or designee’s 

determination regarding the need for 

restrictions. 

(c) Evaluation of disruptive behavior. 

In making determinations under 

paragraph (b) of this section, the Chief 

of Staff or designee must consider all 

pertinent facts, including any prior 

counseling of the patient regarding his 

or her disruptive behavior or any 

pattern of such behavior, and whether 

the disruptive behavior is a result of the 

patient’s individual fears, preferences, 

or perceived needs. A patient’s 

disruptive behavior must be assessed in 

connection with VA’s duty to provide 

good quality care, including care 

designed to reduce or otherwise 

clinically address the patient’s behavior. 

(d) Restrictions. The restrictions on 

care imposed under this section may 

include but are not limited to: 

(1) Specifying the hours in which 

nonemergent outpatient care will be 

provided; 

(2) Arranging for medical and any 

other services to be provided in a 

particular patient care area (e.g., private 

exam room near an exit); 

(3) Arranging for medical and any 

other services to be provided at a 

specific site of care; 

(4) Specifying the health care 

provider, and related personnel, who 

will be involved with the patient’s care; 

(5) Requiring police escort; or 

(6) Authorizing VA providers to 

terminate an encounter immediately if 

certain behaviors occur. 

(e) Review of restrictions. The patient 

may request the Network Director’s 

review of any order issued under this 

section within 30 days of the effective 

date of the order by submitting a written 

request to the Chief of Staff. The Chief 

of Staff shall forward the order and the 

patient’s request to the Network Director 

for a final decision. The Network 

Director shall issue a final decision on 

this matter within 30 days. VA will 

enforce the order while it is under 

review by the Network Director. The 

Chief of Staff will provide the patient 

who made the request written notice of 

the Network Director’s final decision. 

Note to § 17.106: Although VA may restrict 

the time, place, and/or manner of care under 

this section, VA will continue to offer the full 

range of needed medical care to which a 

patient is eligible under title 38 of the United 

States Code or Code of Federal Regulations. 

Patients have the right to accept or refuse 

treatments or procedures, and such refusal by 

a patient is not a basis for restricting the 

provision of care under this section. 

(Authority: 38 U.S.C. 501, 901, 1721) 

[FR Doc. 2010–28711 Filed 11–15–10; 8:45 am] 

BILLING CODE 8320–01–P 

ENVIRONMENTAL PROTECTION 

AGENCY 

40 CFR Part 52 

[Docket No. EPA–R02–OAR–2010–0872; 

FRL–9225–8] 

Adequacy Status of the Submitted 

2009 PM2.5 Motor Vehicle Emission 

Budgets for Transportation Conformity 

Purposes for the New York Portions of 

New York-Northern New Jersey-Long 

Island, NY-NJ-CT PM2.5 Nonattainment 

Area; New York 

AGENCY: Environmental Protection 

Agency (EPA). 

ACTION: Finding of adequacy. 

SUMMARY: In this document, EPA is 

notifying the public that it has found the 

motor vehicle emissions budgets for 

PM2.5 and NOX in the submitted 

attainment demonstration state 

implementation plans for the New York 

portion of the New York-Northern New 

Jersey-Long Island, NY-NJ-CT PM2.5

nonattainment area to be adequate for 

transportation conformity purposes. The 

transportation conformity rule requires 

that the EPA conduct a public process 

and make an affirmative decision on the 

adequacy of budgets before they can be 

used by metropolitan planning 

organizations in conformity 

determinations. As a result of our 

finding, the New York Metropolitan 

Transportation Council (excluding 

Putnam County) and the Orange County 

Transportation Council must use the 

new 2009 PM2.5 budgets for future 

transportation conformity 

determinations. 

DATES: This finding is effective 

December 1, 2010. 

FOR FURTHER INFORMATION CONTACT: 

Melanie Zeman, Air Programs Branch, 

Environmental Protection Agency— 

Region 2, 290 Broadway, 25th Floor, 

New York, New York 10007–1866, (212) 

637–4022, zeman.melanie@epa.gov. 

The finding and the response to 

comments will be available at EPA’s 

conformity Web site: http://

www.epa.gov/otaq/stateresources/

transconf/adequacy.htm. 

SUPPLEMENTARY INFORMATION: 

Background 

On October 27, 2009, the State of New 

York submitted an attainment 

demonstration state implementation 

plan to EPA for the New York portion 

of the New York-Northern New JerseyLong Island, NY-NJ-CT PM2.5

nonattainment area. The purpose of 

New York State’s submittal was to 

demonstrate the State’s progress toward 


jlentini on DSKJ8SOYB1PROD with RULES
69884 Federal Register / Vol. 75, No. 220 / Tuesday, November 16, 2010 / Rules and Regulations 

attaining the 1997 PM2.5 National 

Ambient Air Quality Standard (62 FR 

38652, July 18, 1997). New York State’s 

submittal included motor vehicle 

emissions budgets (‘‘budgets’’) for 2009 

for use by the State’s metropolitan 

planning organizations in making 

transportation conformity 

determinations. On January 19, 2010, 

EPA posted the availability of the 

budgets on our Web site for the purpose 

of soliciting public comments. The 

comment period closed on February 18, 

2010, and we received no comments. 

Today’s notice is simply an 

announcement of a finding that we have 

already made. EPA Region 2 sent a letter 

to New York State on October 15, 2010, 

stating that the 2009 motor vehicle 

emissions budgets in New York’s SIP for 

the New York portion of the New YorkNorthern New Jersey-Long Island, NY– 

NJ–CT PM2.5 nonattainment area are 

adequate because they are consistent 

with the required attainment 

demonstration. 

Transportation conformity is required 

by section 176(c) of the Clean Air Act. 

EPA’s conformity rule requires that 

transportation plans, programs, and 

projects conform to SIPs and establishes 

the criteria and procedures for 

determining whether or not they 

conform. Conformity to a SIP means that 

transportation activities will not 

produce new air quality violations, 

worsen existing violations, or delay 

timely attainment of the National 

Ambient Air Quality Standards. 

The criteria by which we determine 

whether a SIP’s motor vehicle emission 

budgets are adequate for conformity 

purposes are outlined in 40 CFR 

93.118(e)(4). Please note that an 

adequacy review is separate from EPA’s 

completeness review, and it also should 

not be used to prejudge EPA’s ultimate 

approval of the SIP. Even if we find a 

budget adequate, the SIP could later be 

disapproved. 

We have described our process for 

determining the adequacy of submitted 

SIP budgets in 40 CFR 93.118(f). We 

have followed this rule in making our 

adequacy determination. The motor 

vehicle emissions budgets being found 

adequate today are listed in Table 1. 

EPA’s finding will also be announced 

on EPA’s conformity Web site: http://

www.epa.gov/otaq/stateresources/

transconf/adequacy.htm. 

TABLE 1—2009 ATTAINMENT PM2.5

MOTOR VEHICLE EMISSIONS BUDGETS FOR NEW YORK

[Tons per year] 

Metropolitan Planning 

Organization PM2.5 NOX

NYMTC (excluding Putnam County) and OCTC 1,750 77,571 

List of Subjects in 40 CFR Part 52 

Environmental protection, Air 

pollution control, Incorporation by 

reference, Intergovernmental relations, 

Nitrogen dioxide, Particulate matter, 

Reporting and record keeping 

requirements. 

Authority: 42 U.S.C. 7401–7671q. 

Dated: October 29, 2010. 

Judith A. Enck, 

Regional Administrator, Region 2. 

[FR Doc. 2010–28658 Filed 11–15–10; 8:45 am] 

BILLING CODE 6560–50–P 

ENVIRONMENTAL PROTECTION 

AGENCY 

40 CFR Part 52 

[EPA–R06–OAR–2005–TX–0012; FRL–9226– 

2] 

Approval and Promulgation of 

Implementation Plans; Texas; 

Emissions Banking and Trading of 

Allowances Program 

AGENCY: Environmental Protection 

Agency (EPA). 

ACTION: Direct final rule. 

SUMMARY: EPA is taking a direct final 

action to approve portions of four 

revisions to the Texas State 

Implementation Plan (SIP) that create 

and amend the Emissions Banking and 

Trading of Allowances (EBTA) Program. 

The EBTA Program establishes a cap 

and trade program to reduce emissions 

of oxides of nitrogen (NOX) and sulfur 

dioxide (SO2) from participating electric 

generating facilities. The Texas 

Commission on Environmental Quality 

(TCEQ) originally submitted the EBTA 

program to EPA as a SIP revision on 

January 3, 2000. Since that time, the 

TCEQ has submitted SIP revisions for 

the EBTA Program on September 11, 

2000; July 15, 2002; and October 24, 

2006. EPA has determined that these 

changes to the Texas SIP comply with 

the Federal Clean Air Act (the Act or 

CAA) and EPA regulations, are 

consistent with EPA policies, and will 

improve air quality. This action is being 

taken under section 110 and parts C and 

D of the Act. 

DATES: This direct final rule is effective 

on January 18, 2011 without further 

notice, unless EPA receives relevant 

adverse comment by December 16, 

2010. If EPA receives such comment, 

EPA will publish a timely withdrawal in 

the Federal Register informing the 

public that this rule will not take effect. 

ADDRESSES: Submit your comments, 

identified by Docket ID No. EPA–R06– 

OAR–2005–TX–0012, by one of the 

following methods: 

• www.regulations.gov: Follow the 

on-line instructions for submitting 

comments. 

• E-mail: Mr. Jeff Robinson at 

robinson.jeffrey@epa.gov. Please also cc 

the person listed in the FOR FURTHER

INFORMATION CONTACT paragraph below. 

• U.S. EPA Region 6 ‘‘Contact Us’’ 

Web site: http://epa.gov/region6/

r6coment.htm. Please click on ‘‘6PD’’ 

(Multimedia) and select ‘‘Air’’ before 

submitting comments. 

• Fax: Mr. Jeff Robinson, Chief, Air 

Permits Section (6PD–R), at fax number 

214–665–6762. 

• Mail: Mr. Jeff Robinson, Chief, Air 

Permits Section (6PD–R), Environmental 

Protection Agency, 1445 Ross Avenue, 

Suite 1200, Dallas, Texas 75202–2733. 

• Hand or Courier Delivery: Mr. Jeff 

Robinson, Chief, Air Permits Section 

(6PD–R), Environmental Protection 

Agency, 1445 Ross Avenue, Suite 1200, 

Dallas, Texas 75202–2733. Such 

deliveries are accepted only between the 

hours of 8:30 a.m. and 4:30 p.m. 

weekdays except for legal holidays. 

Special arrangements should be made 

for deliveries of boxed information. 

Instructions: Direct your comments to 

Docket ID No. EPA–R06–OAR–2005– 

TX–0012. EPA’s policy is that all 

comments received will be included in 

the public docket without change and 

may be made available online at 

http://www.regulations.gov, including 

any personal information provided, 

unless the comment includes 

information claimed to be Confidential 

Business Information (CBI) or other 

information the disclosure of which is 

restricted by statute. Do not submit 

information through http://www.

regulations.gov or e-mail, if you believe 

that it is CBI or otherwise protected 

from disclosure. The http://www.

regulations.gov website is an 

‘‘anonymous access’’ system, which 

means that EPA will not know your 

identity or contact information unless 

you provide it in the body of your 

comment. If you send an e-mail 

comment directly to EPA without going 

through http://www.regulations.gov, 

your e-mail address will be 

automatically captured and included as 


jlentini on DSKJ8SOYB1PROD with RULES