Federal Register / Vol. 75, No. 220 / Tuesday, November 16, 2010 / Rules and Regulations 69879 

mail Waverly.W.Gregory@uscg.mil. If 

you have questions on viewing the 

docket, call Renee V. Wright, Program 

Manager, Docket Operations, telephone 

202–366–9826. 

SUPPLEMENTARY INFORMATION: The 

Norfolk Southern Railway (NSR) owns 

and operates the swing span of the 

Neuse River Railroad Bridge across 

Neuse River in New Bern NC. The 

bridge has zero vertical clearance in the 

closed position to vessels, above mean 

high water. The current operating 

regulations are outlined at 33 CFR 

117.5, which requires the bridge to open 

promptly and fully for the passage of 

vessels when a request to open is given. 

NSR has requested a temporary 

deviation to the existing regulations for 

the Neuse River Railroad Bridge to 

facilitate mechanical repairs. The 

repairs consist of removing, 

refurbishing, and replacing of drive 

shaft bearings, wedge blocks, rail levers, 

and turnbuckles. 

Under this deviation, the swing span 

of the drawbridge will be maintained in 

the closed-to-navigation position from 8 

a.m. on November 16, 2010, through 8 

a.m. on November 18, 2010. 

According to information furnished 

by NSR, the swing span normally 

remains open to vessels, closing to 

permit rail traffic usually four times in 

a 24-hour period and these closures 

generally occur between 11 p.m. and 

10 a.m. In 2009, between 10 a.m. and 

11 p.m., vessel traffic passing at the 

swing span typically consisted of four 

yachts. 

The Coast Guard will inform the users 

of the waterway through our Local and 

Broadcast Notices to Mariners of the 

closure period so that vessels can 

arrange their transits to minimize any 

impact caused by the temporary 

deviation. 

There are no alternate routes for 

vessels transiting this section of the 

Neuse River and the drawbridge will be 

unable to open in the event of an 

emergency. 

In accordance with 33 CFR 117.35(e), 

the drawbridge must return to its regular 

operating schedule immediately at the 

end of the designated time period. This 

deviation from the operating regulation 

is authorized under 33 CFR 117.35. 

Dated: November 2, 2010. 

Waverly W. Gregory, Jr. 

Chief, Bridge Administration Branch, Fifth 

Coast Guard District. 

[FR Doc. 2010–28736 Filed 11–15–10; 8:45 am] 

BILLING CODE 9110–04–P 

DEPARTMENT OF HOMELAND 

SECURITY 

Coast Guard 

33 CFR Part 117 

[Docket No. USCG–2010–0879] 

Drawbridge Operation Regulations; 

Atlantic Intracoastal Waterway (AIWW), 

Elizabeth River, Southern Branch, VA 

AGENCY: Coast Guard, DHS. 

ACTION: Notice of temporary deviation 

from regulations; request for comments. 

SUMMARY: The Commander, Fifth Coast 

Guard District, has issued a temporary 

deviation from the regulation governing 

the operation of the Gilmerton (US13/ 

460) Bridge across the Elizabeth River 

(Southern Branch), AIWW mile 5.8, at 

Chesapeake, VA. This deviation will test 

a change to the drawbridge operation 

schedule to determine whether a 

schedule change is needed. This 

deviation will allow the bridge to 

remain in the closed position for certain 

vessels for longer morning and evening 

rush hour periods during the weekdays 

and will implement scheduled bridge 

openings between the rush hours and on 

the weekends. 

DATES: This deviation is effective from 

6:30 a.m. on December 20, 2010 through 

6:30 p.m. on June 18, 2011. 

Comments and related material must 

be received by the Coast Guard on or 

before April 18, 2011. 

ADDRESSES: You may submit comments 

identified by docket number USCG– 

2010–0879 using any one of the 

following methods: 

(1) Federal Rulemaking Portal: 

http://www.regulations.gov. 

(2) Fax: 202–493–2251. 

(3) Mail: Docket Management Facility 

(M–30), U.S. Department of 

Transportation, West Building Ground 

Floor, Room W12–140, 1200 New Jersey 

Avenue, SE., Washington, DC 20590– 

0001. 

(4) Hand delivery: Same as mail 

address above, between 9 a.m. and 

5 p.m., Monday through Friday, except 

Federal holidays. The telephone number 

is 202–366–9329. 

To avoid duplication, please use only 

one of these methods. See the ‘‘Public 

Participation and Request for 

Comments’’ portion of the 

SUPPLEMENTARY INFORMATION section 

below for instructions on submitting 

comments. 

FOR FURTHER INFORMATION CONTACT: If 

you have questions on this proposed 

rule, call or e-mail Bill H. Brazier, 

Bridge Management Specialist, Fifth 

Coast Guard District; telephone 757– 

398–6422, e-mail 

Bill.H.Brazier@uscg.mil. If you have 

questions on viewing or submitting 

material to the docket, call Renee V. 

Wright, Program Manager, Docket 

Operations, telephone 202–366–9826. 

SUPPLEMENTARY INFORMATION: 

Public Participation and Request for 

Comments 

We encourage you to participate in 

this rulemaking by submitting 

comments and related materials. All 

comments received will be posted, 

without change, to http:// 

www.regulations.gov and will include 

any personal information you have 

provided. 

Submitting Comments 

If you submit a comment, please 

include the docket number for this 

rulemaking (USCG–2010–0879), 

indicate the specific section of this 

document to which each comment 

applies, and provide a reason for each 

suggestion or recommendation. You 

may submit your comments and 

material online (http:// 

www.regulations.gov), or by fax, mail or 

hand delivery, but please use only one 

of these means. If you submit a 

comment online via http:// 

www.regulations.gov, it will be 

considered received by the Coast Guard 

when you successfully transmit the 

comment. If you fax, hand delivery, or 

mail your comment, it will be 

considered as having been received by 

the Coast Guard when it is received at 

the Docket Management Facility. We 

recommend that you include your name 

and a mailing address, an e-mail 

address, or a phone number in the body 

of your document so that we can contact 

you if we have questions regarding your 

submission. 

To submit your comment online, go to 

http://www.regulations.gov, click on the 

‘‘submit a comment’’ box, which will 

then become highlighted in blue. In the 

‘‘Keyword’’ box insert ‘‘USCG–2010– 

0879,’’ click ‘‘Search,’’ and then click on 

the balloon shape in the ‘‘Actions’’ 

column. If you submit your comments 

by mail or hand delivery, submit them 

in an unbound format, no larger than 

81⁄2 by 11 inches, suitable for copying 

and electronic filing. If you submit them 

by mail and would like to know that 

they reached the Facility, please enclose 

a stamped, self-addressed postcard or 

envelope. We will consider all 

comments and material received during 

the comment period and may change 

the rule based on your comments. 


jlentini on DSKJ8SOYB1PROD with RULES
69880 Federal Register / Vol. 75, No. 220 / Tuesday, November 16, 2010 / Rules and Regulations 

Viewing Comments and Documents 

To view comments, as well as 

documents mentioned in this preamble 

as being available in the docket, go to 

http://www.regulations.gov, click on the 

‘‘read comments’’ box, which will then 

become highlighted in blue. In the 

‘‘Keyword’’ box insert ‘‘USCG–2010– 

0879’’ and click ‘‘Search.’’ Click the 

‘‘Open Docket Folder’’ in the ‘‘Actions’’ 

column. You may also visit the Docket 

Management Facility in Room W12–140 

on the ground floor of the Department 

of Transportation West Building, 1200 

New Jersey Avenue, SE., Washington, 

DC 20590, between 9 a.m. and 5 p.m., 

Monday through Friday, except Federal 

holidays. We have an agreement with 

the Department of Transportation to use 

the Docket Management Facility. 

Privacy Act 

Anyone can search the electronic 

form of comments received into any of 

our dockets by the name of the 

individual submitting the comment (or 

signing the comment, if submitted on 

behalf of an association, business, labor 

union, etc.). You may review a Privacy 

Act notice regarding our public dockets 

in the January 17, 2008, issue of the 

Federal Register (73 FR 3316). 

Public Meeting 

We do not now plan to hold a public 

meeting. But you may submit a request 

for one using one of the four methods 

specified under ADDRESSES. Please 

explain why one would be beneficial. If 

we determine that one would aid this 

rulemaking, we will hold one at a time 

and place announced by a later notice 

in the Federal Register. 

Basis and Purpose 

The City of Chesapeake, Virginia (the 

City), who owns and operates the lifttype Gilmerton (US13/460) Bridge, has 

requested a temporary deviation to the 

existing bridge regulations. The normal 

operating schedule requires the 

Gilmerton (US13/460) Bridge, at AIWW 

mile 5.8 in Chesapeake, with a vertical 

clearance of seven feet above mean high 

tide in the closed position, to open on 

signal at anytime for commercial vessels 

carrying liquefied flammable gas or 

other hazardous materials. From 6:30 

a.m. to 8:30 a.m. and from 3:30 p.m. to 

5:30 p.m. Monday through Friday, 

except Federal holidays, the draw need 

not open for the passage of recreational 

or commercial vessels; except the draw 

shall open any time for commercial 

cargo vessels, including tugs, and tugs 

with tows, if two hours advance notice 

is given to the Gilmerton Bridge at (757) 

545–1512. In addition, the draw shall 

open on signal at all other times as 

required by 33 CFR 117.995(c). The 

current operating schedule has been in 

effect since November 17, 2003. 

The Gilmerton Bridge Replacement 

project, which has been underway since 

November 2009, will provide a new 

vertical-lift type bridge over the 

Southern Branch of the Elizabeth River 

to replace the existing bridge that was 

constructed in 1938. 

Due to the construction for the new 

Gilmerton (US13/460) Bridge, traffic is 

limited to one lane in each direction for 

the next three years. This test deviation 

will allow the City to monitor, measure, 

and identify congested roadway 

locations during heavy traffic periods. 

By expanding the morning and evening 

rush hour periods on the weekdays and 

implementing scheduled bridge 

openings between the rush hour periods 

and on the weekends, we anticipate a 

decrease in vehicular traffic congestion 

during the daytime hours. 

During this test deviation, the City 

will gather data from the scheduled 

openings, along with vessel counts, to 

compare, evaluate, and monitor both old 

and new traffic patterns in hope of 

reducing roadway congestion on the 

bridge and local commuting area by 

adjusting bridge openings to ensure any 

future regulation will not have a 

significant impact on navigation. Vessel 

traffic on this waterway consists of 

pleasure craft, tug and barge traffic, and 

ships with assist tugs. There are no 

alternate routes for vessels transiting 

this section of the Atlantic Intracoastal 

Waterway and the drawbridge will be 

able to open in the event of an 

emergency. 

According to records furnished by the 

City, there were a total of 6,195 bridge 

openings and 12,498 vessel passages 

occurring at the drawbridge between 

September 2009 and September 2010. 

(See Table A) 

TABLE A 

2009 2009 2009 2009 2010 2010 2010 2010 2010 2010 2010 2010 2010 

SEP OCT NOV DEC JAN FEB MAR APR MAY JUN JUL AUG SEP 

BRIDGE OPENINGS FOR SEPTEMBER 2009–SEPTEMBER 2010 

551 621 549 503 299 284 317 476 639 616 459 365 516 

BOAT PASSAGES FOR SEPTEMBER 2009–SEPTEMBER 2010 

892 1,858 1,361 645 406 392 478 967 1,770 1,408 791 628 902 

Under normal conditions, the 

Gilmerton (US13/460) Bridge is a vital 

transportation route for over 35,000 

motorists per day. According to recent 

vehicular traffic counts submitted by the 

City, the average daily traffic volume 

decreased at the Gilmerton (US13/460) 

Bridge to approximately 20,000 cars a 

day. Due to construction, the I–64 High 

Rise Bridge is the suggested alternate 

route for motorists. Even with the 

alternative vehicular route, the Coast 

Guard anticipates a continued increase 

in vehicular traffic congestion over the 

Gilmerton (US13/460) Bridge due to the 

previously referenced vehicular traffic 

limitations. 

A Notice of Proposed Rulemaking, 

USCG–2010–0879, is being issued in 

conjunction with this Temporary 

Deviation to obtain additional public 

comments. The proposed rule will be in 

effect for three years until December 20, 

2013. 

The Coast Guard will evaluate public 

comments from this Test Deviation and 

the above-referenced Notice of Proposed 

Rulemaking to determine if a temporary 

change to the drawbridge operating 

regulation at 33 CFR 117.997(c) is 

warranted. 

From 6:30 a.m. on December 20, 2010 

through 6:30 p.m. on June 18, 2011, the 

draw of the Gilmerton (US13/460) 

Bridge, at AIWW mile 5.8, shall open on 

signal at any time for commercial 

vessels carrying liquefied flammable gas 

or other hazardous materials. From 6:30 

a.m. to 9:30 a.m. and from 3:30 p.m. to 

6:30 p.m., Monday through Friday, 

except Federal holidays, the draw need 

not open for the passage of recreational 


jlentini on DSKJ8SOYB1PROD with RULES
Federal Register / Vol. 75, No. 220 / Tuesday, November 16, 2010 / Rules and Regulations 69881 

or commercial vessels; except the draw 

shall open anytime for commercial 

cargo vessels, including tugs, and tugs 

with tows, if two hours advance notice 

is given to the Gilmerton Bridge at (757) 

545–1512. 

From 9:30 a.m. to 3:30 p.m. Monday 

through Friday and from 6:30 a.m. to 

6:30 p.m. Saturdays, Sundays and 

Federal holidays, the draw shall open 

on signal hourly on the half hour; 

except the draw shall open anytime for 

commercial cargo vessels, including 

tugs, and tugs with tows, if two hours 

advance notice is given to the Gilmerton 

Bridge at (757) 545–1512. At all other 

times, the draw shall open on signal. 

We anticipate a decrease in vehicular 

traffic congestion at the bridge, with no 

impact to vessels passing under the 

bridge in the closed position; however 

we foresee slight delays to vessels while 

transitioning to the new test opening 

schedule. 

This test deviation has been 

coordinated with the main commercial 

waterway user group, specifically, the 

Virginia Maritime Association who 

represents waterborne commerce in the 

Port of Hampton and there is no 

expectation of any significant impacts 

on navigation. Vessels with a mast 

height of less than seven feet can pass 

underneath the bridge in the closed 

position. There are no alternate 

waterway routes. 

In accordance with 33 CFR 117.35(e), 

the drawbridge must return to its regular 

operating schedule immediately at the 

end of the designated time period. This 

deviation from the operating regulations 

is authorized under 33 CFR 117.35. 

Dated: November 2, 2010. 

Patrick B. Trapp, 

Captain, U.S. Coast Guard, Acting 

Commander, Fifth Coast Guard District. 

[FR Doc. 2010–28737 Filed 11–15–10; 8:45 am] 

BILLING CODE 9110–04–P 

DEPARTMENT OF VETERANS 

AFFAIRS 

38 CFR Part 17 

RIN 2900–AN45 

Responding to Disruptive Patients 

AGENCY: Department of Veterans Affairs. 

ACTION: Final rule. 

SUMMARY: This final rule amends the 

Department of Veterans Affairs (VA) 

regulation that authorizes appropriate 

action when a patient engages in 

disruptive behavior at a VA medical 

facility. This amendment updates VA’s 

current regulation to reflect modern 

medical care and ethical practices. The 

final rule authorizes VA to modify the 

time, place, and/or manner in which VA 

provides treatment to a patient, in order 

to ensure the safety of others at VA 

medical facilities, and to prevent any 

interference with the provision of 

medical care. 

DATES: This final rule is effective 

December 16, 2010. 

FOR FURTHER INFORMATION CONTACT: 

Roscoe Butler, Acting Director, Business 

Policy, Chief Business Office (163), 

Veterans Health Administration, 

Department of Veterans Affairs, 810 

Vermont Avenue, NW., Washington, DC 

20420, (202) 461–1586. (This is not a 

toll free number.) 

SUPPLEMENTARY INFORMATION: Under 38 

U.S.C. chapters 17 and 18, VA has 

authority to provide medical care to 

certain veterans and non-veterans. VA is 

required, per 38 U.S.C. 1721, to 

prescribe rules and regulations to 

promote good conduct on the part of VA 

patients. VA has implemented this 

authority in 38 CFR part 17. 

Regarding the rights of patients 

receiving VA care, 38 CFR 17.33(a) 

prescribes, in part, that patients have ‘‘a 

right to be treated with dignity in a 

humane environment that affords them 

both reasonable protection from harm 

and appropriate privacy with regard to 

their personal needs.’’ Patients also have 

‘‘a right to receive, to the extent of 

eligibility therefor under the law, 

prompt and appropriate treatment for 

any physical or emotional disability.’’ 

Section 17.33(b) also prescribes rights 

with respect to visitations and 

communications, clothing, personal 

possessions, money, social interaction, 

exercise, and worship for VA residents 

and inpatients. These rights may be 

restricted by the appropriate health care 

professional in certain circumstances. 

See 38 CFR 17.33(c). The restrictions 

authorized by § 17.33(c), however, do 

not apply to outpatients and only cover 

restrictions on the listed rights. In 

certain cases, VA must restrict the 

provision of medical care to a patient in 

order to prevent harm to other patients 

and VA staff and disruptions in VA’s 

provision of medical care due to the 

patient’s behavior. 

VA regulations also prescribe rules of 

conduct for patients and other 

individuals who have access to VA 

facilities. See 38 CFR 1.218. In 

particular, § 1.218(a)(5) prohibits 

persons on VA property from causing a 

wide variety of disturbances, including 

creating ‘‘loud or unusual noise,’’ 

obstructing public areas, and impeding 

or disrupting ‘‘the performance of 

official duties by Government 

employees.’’ The sole enforcement 

mechanism provided by paragraph (a)(5) 

is ‘‘arrest and removal from the 

premises.’’ 38 CFR 1.218(a)(5). VA has 

determined that arrest is generally not 

an appropriate remedy in a situation 

where the Department must balance the 

rights and needs of a disruptive patient 

against the need to protect other 

patients, guests, and staff. Some patients 

establish a pattern of disruptive 

behavior when interacting with VA 

personnel or when they are on VA 

property, and we believe that by 

understanding these patterns of 

behavior, planning for such behavior in 

advance, and setting safe conditions for 

care delivery, we can intervene in ways 

that can prevent subsequent episodes 

requiring removal and arrest. 

In addition to §§ 1.218 and 17.33, the 

behavior of patients is specifically 

governed by current 38 CFR 17.106. It 

requires, in part, that VA maintain the 

good conduct of patients through 

‘‘corrective and disciplinary procedure.’’ 

However, current § 17.106, which VA 

promulgated in 1973 and last amended 

over 10 years ago, does not adequately 

reflect modern practice or VA’s policy 

regarding disruptive patients in the 

health care setting, which opposes the 

use of punishment in the management 

of disruptive patients. Instead, it reflects 

the view that patients exhibiting 

disruptive behavior must be punished. 

For example, current § 17.106 

emphasizes disciplining patients who 

do not engage in ‘‘good conduct,’’ and 

includes measures (such as withholding 

pass privileges) that do not differentiate 

between providing care and ensuring 

the safety of others. Moreover, the 

current rule could be viewed as 

interfering with VA’s legal obligation to 

provide medical care to certain veterans 

and non-veterans. Accordingly, VA has 

determined that amendments to current 

regulations are necessary to implement 

its policy regarding disruptive patients, 

which emphasizes continuation of 

treatment. 

On June 1, 2010, we proposed to 

amend § 17.106 to prescribe the 

remedial measures VA will take when a 

patient is disruptive and the procedures 

for implementing those measures. 75 FR 

30,306. We stated that our intent was to 

minimize the risk of a particular patient 

jeopardizing the health or safety of 

others, or disrupting the safe provision 

of medical care to another patient, in a 

VA medical facility. We received three 

comments on the proposed rule. All of 

the commenters supported the proposed 

rule, and there were no adverse 

comments on the content of the 

proposed regulation text or on the 

rationales for the regulation text that we 


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