Bill Text: CA SB253 | 2015-2016 | Regular Session | Enrolled
Bill Title: Juveniles: psychotropic medication.
Spectrum: Partisan Bill (Democrat 5-0)
Status: (Vetoed) 2016-11-30 - Last day to consider Governor's veto pursuant to Joint Rule 58.5. [SB253 Detail]
Download: California-2015-SB253-Enrolled.html
BILL NUMBER: SB 253 ENROLLED
BILL TEXT
PASSED THE SENATE AUGUST 24, 2016
PASSED THE ASSEMBLY AUGUST 18, 2016
AMENDED IN ASSEMBLY AUGUST 4, 2016
AMENDED IN ASSEMBLY AUGUST 31, 2015
AMENDED IN ASSEMBLY JULY 8, 2015
AMENDED IN ASSEMBLY JULY 1, 2015
AMENDED IN SENATE JUNE 2, 2015
AMENDED IN SENATE MAY 5, 2015
AMENDED IN SENATE APRIL 22, 2015
AMENDED IN SENATE MARCH 23, 2015
INTRODUCED BY Senator Monning
(Principal coauthor: Assembly Member Chiu)
(Coauthors: Senators Beall and Leno)
(Coauthor: Assembly Member Gatto)
FEBRUARY 18, 2015
An act to amend Section 4064.5 of the Business and Professions
Code, and to amend, repeal, and add Sections 369.5 and 739.5 of, and
to add Section 369.4 to, the Welfare and Institutions Code, relating
to juveniles.
LEGISLATIVE COUNSEL'S DIGEST
SB 253, Monning. Juveniles: psychotropic medication.
Existing law establishes the jurisdiction of the juvenile court,
which may adjudge children to be dependents or wards of the court
under certain circumstances. Existing law authorizes only a juvenile
court judicial officer to make orders regarding the administration of
psychotropic medications for a dependent or delinquent child who has
been removed from the physical custody of his or her parent.
Existing law requires that court authorization for the administration
of psychotropic medication to a child be based on a request from a
physician, indicating the reasons for the request, a description of
the child's diagnosis and behavior, the expected results of the
medication, and a description of any side effects of the medication.
Existing law requires the Judicial Council to adopt rules of court
and develop appropriate forms for the implementation of these
provisions, as specified.
This bill, commencing January 1, 2018, would require that an order
authorizing the administration of psychotropic medications to a
dependent child or a delinquent child in foster care be granted only
upon the court's determination that the administration of the
medication is in the best interest of the child and that specified
requirements have been met, including a requirement that the
prescribing physician confirms that all appropriate laboratory
screenings or tests have been performed or ordered for the child, as
specified. Under specified circumstances, the bill would prohibit the
court from authorizing the administration of psychotropic
medications to a child under those provisions, unless a
preauthorization review is obtained from a child psychiatrist or
behavioral pediatrician, as specified. The bill would impose
additional requirements on the court to implement these provisions
and to conduct review hearings, as specified. The bill would require
the child's social worker to submit a report to the court prior to
any review hearing, to include information from the child, the child'
s caregiver, the public health nurse, and the court-appointed special
advocate. By increasing the duties of county social workers, the
bill would impose a state-mandated local program. The bill would
authorize psychotropic medication to be administered in an emergency
without court authorization. The bill would require court
authorization to be sought as soon as practical thereafter, but in no
case more than 2 court days after emergency administration of the
psychotropic medication. The bill would require the Judicial Council
to adopt rules of court and develop appropriate forms to implement
these provisions by January 1, 2018.
This bill would also require the State Department of Health Care
Services, in collaboration with the Judicial Council, to identify
resources to assist courts in securing preauthorization reviews in
those counties in which there are fewer than 10 practicing child and
adolescent psychiatrists in order to avoid undue delays in the
authorization of psychotropic medications.
This bill would incorporate changes to Section 4064.5 of the
Business and Professions Code proposed by both this bill and SB 999,
which would become operative only if both bills are enacted and
become effective on or before January 1, 2017, and this bill is
chaptered last.
The California Constitution requires the state to reimburse local
agencies and school districts for certain costs mandated by the
state. Statutory provisions establish procedures for making that
reimbursement.
This bill would provide that no reimbursement is required by this
act for a specified reason.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 4064.5 of the Business and Professions Code is
amended to read:
4064.5. (a) A pharmacist may dispense not more than a 90-day
supply of a dangerous drug other than a controlled substance pursuant
to a valid prescription that specifies an initial quantity of less
than a 90-day supply followed by periodic refills of that amount if
all of the following requirements are satisfied:
(1) The patient has completed an initial 30-day supply of the
dangerous drug.
(2) The total quantity of dosage units dispensed does not exceed
the total quantity of dosage units authorized by the prescriber on
the prescription, including refills.
(3) The prescriber has not specified on the prescription that
dispensing the prescription in an initial amount followed by periodic
refills is medically necessary.
(4) The pharmacist is exercising his or her professional judgment.
(b) For purposes of this section, if the prescription continues
the same medication as previously dispensed in a 90-day supply, the
initial 30-day supply under paragraph (1) of subdivision (a) is not
required.
(c) A pharmacist dispensing an increased supply of a dangerous
drug pursuant to this section shall notify the prescriber of the
increase in the quantity of dosage units dispensed.
(d) In no case shall a pharmacist dispense a greater supply of a
dangerous drug pursuant to this section if the prescriber personally
indicates, either orally or in his or her own handwriting, "No change
to quantity," or words of similar meaning. Nothing in this
subdivision shall prohibit a prescriber from checking a box on a
prescription marked "No change to quantity," provided that the
prescriber personally initials the box or checkmark. To indicate that
an increased supply shall not be dispensed pursuant to this section
for an electronic data transmission prescription as defined in
subdivision (c) of Section 4040, a prescriber may indicate "No change
to quantity," or words of similar meaning, in the prescription as
transmitted by electronic data, or may check a box marked on the
prescription "No change to quantity." In either instance, it shall
not be required that the prohibition on an increased supply be
manually initialed by the prescriber.
(e) This section does not apply to psychotropic medication or
psychotropic drugs as described in Sections 369.5 and 739.5 of the
Welfare and Institutions Code.
(f) Nothing in this section shall be construed to require a health
care service plan, health insurer, workers' compensation insurance
plan, pharmacy benefits manager, or any other person or entity,
including, but not limited to, a state program or state employer, to
provide coverage for a dangerous drug in a manner inconsistent with a
beneficiary's plan benefit.
SEC. 1.5. Section 4064.5 of the Business and Professions Code is
amended to read:
4064.5. (a) A pharmacist may dispense not more than a 90-day
supply of a dangerous drug other than a controlled substance pursuant
to a valid prescription that specifies an initial quantity of less
than a 90-day supply followed by periodic refills of that amount if
all of the following requirements are satisfied:
(1) The patient has completed an initial 30-day supply of the
dangerous drug.
(2) The total quantity of dosage units dispensed does not exceed
the total quantity of dosage units authorized by the prescriber on
the prescription, including refills.
(3) The prescriber has not specified on the prescription that
dispensing the prescription in an initial amount followed by periodic
refills is medically necessary.
(4) The pharmacist is exercising his or her professional judgment.
(b) For purposes of this section, if the prescription continues
the same medication as previously dispensed in a 90-day supply, the
initial 30-day supply under paragraph (1) of subdivision (a) is not
required.
(c) A pharmacist dispensing an increased supply of a dangerous
drug pursuant to this section shall notify the prescriber of the
increase in the quantity of dosage units dispensed.
(d) In no case shall a pharmacist dispense a greater supply of a
dangerous drug pursuant to this section if the prescriber personally
indicates, either orally or in his or her own handwriting, "No change
to quantity," or words of similar meaning. Nothing in this
subdivision shall prohibit a prescriber from checking a box on a
prescription marked "No change to quantity," provided that the
prescriber personally initials the box or checkmark. To indicate that
an increased supply shall not be dispensed pursuant to this section
for an electronic data transmission prescription as defined in
subdivision (c) of Section 4040, a prescriber may indicate "No change
to quantity," or words of similar meaning, in the prescription as
transmitted by electronic data, or may check a box marked on the
prescription "No change to quantity." In either instance, it shall
not be required that the prohibition on an increased supply be
manually initialed by the prescriber.
(e) This section does not apply to psychotropic medication or
psychotropic drugs as described in Sections 369.5 and 739.5 of the
Welfare and Institutions Code.
(f) Except for the provisions of subdivision (d), this section
does not apply to FDA-approved, self-administered hormonal
contraceptives.
(1) A pharmacist shall dispense, at a patient's request, up to a
12-month supply of an FDA-approved, self-administered hormonal
contraceptive pursuant to a valid prescription that specifies an
initial quantity followed by periodic refills.
(2) A pharmacist furnishing an FDA-approved self-administered
hormonal contraceptive pursuant to Section 4052.3 under protocols
developed by the Board of Pharmacy may furnish, at the patient's
request, up to a 12-month supply at one time.
(3) Nothing in this subdivision shall be construed to require a
pharmacist to dispense or furnish a drug if it would result in a
violation of Section 733.
(g) Nothing in this section shall be construed to require a health
care service plan, health insurer, workers' compensation insurance
plan, pharmacy benefits manager, or any other person or entity,
including, but not limited to, a state program or state employer, to
provide coverage for a dangerous drug in a manner inconsistent with a
beneficiary's plan benefit.
SEC. 2. Section 369.4 is added to the Welfare and Institutions
Code, to read:
369.4. The State Department of Health Care Services, in
collaboration with the Judicial Council, shall identify resources,
which may include, but need not be limited to, university-based
consultation services, to assist the courts in securing
preauthorization reviews in those counties in which there are fewer
than 10 practicing child and adolescent psychiatrists in order to
avoid undue delays in the authorization of medications pursuant to
Sections 369.5 and 739.5.
SEC. 3. Section 369.5 of the Welfare and Institutions Code is
amended to read:
369.5. (a) (1) If a child is adjudged a dependent child of the
court under Section 300 and has been removed from the physical
custody of the parent under Section 361, only a juvenile court
judicial officer shall have authority to make orders regarding the
administration of psychotropic medications for that child. The
juvenile court may issue a specific order delegating this authority
to a parent upon making findings on the record that the parent poses
no danger to the child and has the capacity to authorize psychotropic
medications. Court authorization for the administration of
psychotropic medication shall be based on a request from a physician,
indicating the reasons for the request, a description of the child's
diagnosis and behavior, the expected results of the medication, and
a description of any side effects of the medication.
(2) (A) On or before July 1, 2016, the Judicial Council shall
amend and adopt rules of court and develop appropriate forms for the
implementation of this section, in consultation with the State
Department of Social Services, the State Department of Health Care
Services, and stakeholders, including, but not limited to, the County
Welfare Directors Association of California, the County Behavioral
Health Directors Association of California, the Chief Probation
Officers of California, associations representing current and former
foster children, caregivers, and children's attorneys. This effort
shall be undertaken in coordination with the updates required under
paragraph (2) of subdivision (a) of Section 739.5.
(B) The rules of court and forms developed pursuant to
subparagraph (A) shall address all of the following:
(i) The child and his or her caregiver and court-appointed special
advocate, if any, have an opportunity to provide input on the
medications being prescribed.
(ii) Information regarding the child's overall mental health
assessment and treatment plan is provided to the court.
(iii) Information regarding the rationale for the proposed
medication, provided in the context of past and current treatment
efforts, is provided to the court. This information shall include,
but not be limited to, information on other pharmacological and
nonpharmacological treatments that have been utilized and the child's
response to those treatments, a discussion of symptoms not
alleviated or ameliorated by other current or past treatment efforts,
and an explanation of how the psychotropic medication being
prescribed is expected to improve the child's symptoms.
(iv) Guidance is provided to the court on how to evaluate the
request for authorization, including how to proceed if information,
otherwise required to be included in a request for authorization
under this section, is not included in a request for authorization
submitted to the court.
(C) The rules of court and forms developed pursuant to
subparagraph (A) shall include a process for periodic oversight by
the court of orders regarding the administration of psychotropic
medications that includes the caregiver's and child's observations
regarding the effectiveness of the medication and side effects,
information on medication management appointments and other followup
appointments with medical practitioners, and information on the
delivery of other mental health treatments that are a part of the
child's overall treatment plan. The periodic oversight shall be
facilitated by the county social worker, public health nurse, or
other appropriate county staff. This oversight process shall be
conducted in conjunction with other regularly scheduled court
hearings and reports provided to the court by the county child
welfare agency.
(b) (1) In counties in which the county child welfare agency
completes the request for authorization for the administration of
psychotropic medication, the agency is encouraged to complete the
request within three business days of receipt from the physician of
the information necessary to fully complete the request.
(2) Nothing in this subdivision is intended to change current
local practice or local court rules with respect to the preparation
and submission of requests for authorization for the administration
of psychotropic medication.
(c) (1) Within seven court days from receipt by the court of a
completed request, the juvenile court judicial officer shall either
approve or deny in writing a request for authorization for the
administration of psychotropic medication to the child, or shall,
upon a request by the parent, the legal guardian, or the child's
attorney, or upon its own motion, set the matter for hearing.
(2) Notwithstanding Section 827 or any other law, upon the
approval or denial by the juvenile court judicial officer of a
request for authorization for the administration of psychotropic
medication, the county child welfare agency or other person or entity
who submitted the request shall provide a copy of the court order
approving or denying the request to the child's caregiver.
(d) Psychotropic medication or psychotropic drugs are those
medications administered for the purpose of affecting the central
nervous system to treat psychiatric disorders or illnesses. These
medications include, but are not limited to, anxiolytic agents,
antidepressants, mood stabilizers, antipsychotic medications,
anti-Parkinson agents, hypnotics, medications for dementia, and
psychostimulants.
(e) Nothing in this section is intended to supersede local court
rules regarding a minor's right to participate in mental health
decisions.
(f) This section does not apply to nonminor dependents, as defined
in subdivision (v) of Section 11400.
(g) This section shall remain in effect only until January 1,
2018, and as of that date is repealed, unless a later enacted
statute, that is enacted before January 1, 2018, deletes or extends
that date.
SEC. 4. Section 369.5 is added to the Welfare and Institutions
Code, to read:
369.5. (a) If a child is adjudged a dependent child of the court
under Section 300 and has been removed from the physical custody of
the parent under Section 361, only a juvenile court judicial officer
shall have authority to make orders regarding the administration of
psychotropic medications for that child. The juvenile court may issue
a specific order delegating this authority to a parent, upon making
findings on the record that the parent poses no danger to the child
and has the capacity to authorize psychotropic medications. Court
authorization for the administration of psychotropic medication shall
be based on a request from a physician, indicating the reasons for
the request, a description of the child's diagnosis and behavior, the
expected results of the medication, and a description of any side
effects of the medication. If the court authorizes the administration
of a psychotropic medication, it shall verify that the
administration of the psychotropic medication is only one part of a
comprehensive treatment plan for the child that shall include and
specify the psychosocial, behavioral, and alternative services, if
any, the child will receive in addition to any authorized medication.
(b) (1) An order authorizing the administration of psychotropic
medications pursuant to this section shall be granted only upon the
court's determination that the administration of the medication is in
the best interest of the child based on a determination that the
anticipated benefits of the psychotropic medication outweigh the
short- and long-term risks associated with the medications. An order
authorizing the administration of psychotropic medication pursuant to
this section shall not be granted if the court determines that the
medication is being used as punishment, for purposes other than the
treatment of a diagnosed mental health condition, as a substitute for
other less invasive treatments, or in quantities or dosages that
interfere with the child's treatment program.
(2) An order authorizing the administration of psychotropic
medications pursuant to this section shall be granted only if the
court determines all of the following:
(A) The court is provided documentation confirming the child's
caregiver has been informed, and the child has been informed in an
age and developmentally appropriate manner in the primary language of
the child, about the recommended medications, the anticipated
benefits, the nature, degree, duration, and probability of side
effects and significant risks commonly known by the medical
profession, and of psychosocial treatments and interventions specific
to the identified disorder and symptoms to be considered
concurrently with or as an alternative to the medication.
(i) The documentation shall state that the child and the child's
caregiver have been asked whether either have concerns regarding the
medication, and, if so, shall describe the nature of those concerns.
(ii) The documentation shall confirm that the child has been
informed of the right to object to the authorization of psychotropic
medication and to request a hearing pursuant to paragraph (1) of
subdivision (g).
(iii) The documentation shall include the written consent or
refusal to consent of a child who is 12 years of age or older.
(B) The prescribing physician submitting the request for
psychotropic medication was provided a copy of the child's health and
education summary or passport as described in Section 16010.
(C) The prescribing physician also confirms all of the following:
(i) There are no less invasive treatment options available to meet
the needs of the child.
(ii) The dosage or dosage range requested is appropriate for the
child.
(iii) The short- and long-term risks associated with the use of
psychotropic medications by the child do not outweigh the reported
benefits to the child.
(iv) All appropriate measurements have been completed and all
appropriate laboratory screenings or tests have been performed or
ordered for the child in accordance with accepted medical guidelines.
(D) A plan is in place for regular monitoring of the child's
medication and psychosocial treatment plan, the effectiveness of the
medication and psychosocial treatment, and any potential side effects
of the medication, by the physician in consultation with the
caregiver, mental health care provider, and others who have contact
with the child, as appropriate.
(3) The person or entity submitting the request for authorization
of the administration of psychotropic medication is responsible for
providing the necessary documentation of the clinical appropriateness
of the proposed psychotropic medication and shall bear the burden of
proof.
(c) (1) A court shall not issue an order authorizing the
administration of psychotropic medications for a child described in
subdivision (a) unless a preauthorization review is obtained from a
child psychiatrist or behavioral pediatrician, if one or more of the
following circumstances exist:
(A) The request is for any class of psychotropic medication for a
child who is five years of age or younger.
(B) The request would result in the child being administered three
or more psychotropic medications concurrently.
(C) The request is for the concurrent administration of two
antipsychotic medications unless the request is for medication
tapering and replacement that is limited to no more than 45 days.
(2) Preauthorization review under this subdivision does not
require a face-to-face assessment of the child for whom the
psychotropic medications are prescribed. The court, on its own motion
or upon the request of the child's attorney or the parent or parent'
s attorney, may order that assessment to be completed before deciding
whether or not to approve the request to authorize the medication.
The health care professional providing the preauthorization review
shall review all the information submitted to the court, including,
but not limited to, the prescribing physician's statement and the
child's health and education summary or passport, and, if deemed
necessary, conduct a telephone consultation with the prescriber or
the public health nurse responsible for the child pursuant to Section
16501.3.
(d) The court shall not authorize the administration of the
psychotropic medication for a child described in subdivision (a)
unless the court is provided with documentation that appropriate
laboratory screenings, measurements, or tests for the child have been
completed no more than 45 days prior to submission of the request to
the court in accordance with accepted medical guidelines.
(e) (1) No later than 60 days after the authorization of a new
psychotropic medication is granted or at the next review hearing
scheduled for a child described in subdivision (a), if scheduled no
earlier than 45 days after the authorization of a new psychotropic
medication, the court shall conduct a review hearing to determine all
of the following:
(A) Whether the child is taking the medication or medications.
(B) Whether psychosocial services and other aspects of the child's
treatment plan have been provided to the child.
(C) To what extent the symptoms for which the medication or
medications were authorized have been alleviated.
(D) Whether more time is needed to evaluate the effectiveness of
the medication or medications.
(E) What, if any, adverse effects the child has suffered.
(F) Any steps taken to address those effects.
(G) The date or dates of followup visits with the prescribing
physician since the medication or medications were authorized.
(H) Whether the appropriate followup laboratory screenings have
been performed and their findings.
(2) Prior to the review, the child's social worker shall submit a
report to the court and to counsel for the parties, which shall
include information from the child, the child's caregiver, the public
health nurse, and the court-appointed special advocate, if any.
(3) If, based upon this review, the court determines that the
proffered benefits of the medication have not been demonstrated or
that the risks of the medication outweigh the benefits, the court
shall reconsider, modify, or revoke its authorization for the
administration of medication.
(f) (1) In counties in which the county child welfare agency
completes the request for authorization for the administration of
psychotropic medication, the agency is encouraged to complete the
request within three business days of receipt from the physician of
the information necessary to fully complete the request.
(2) Nothing in this subdivision is intended to change current
local practice or local court rules with respect to the preparation
and submission of requests for authorization for the administration
of psychotropic medication.
(g) (1) Within seven court days from receipt by the court of a
completed request, the juvenile court judicial officer shall either
approve or deny in writing a request for authorization for the
administration of psychotropic medication to the child, refer the
request for a preauthorization review as required by subdivision (c),
or shall, upon a request by the parent, the legal guardian, or the
child's attorney, or upon its own motion, set the matter for hearing.
(2) Notwithstanding Section 827 or any other law, upon the
approval or denial by the juvenile court judicial officer of a
request for authorization for the administration of psychotropic
medication, the county child welfare agency or other person or entity
who submitted the request shall provide a copy of the court order
approving or denying the request to the child's caregiver.
(h) If the court grants the request, or modifies and grants the
request, the order for authorization is effective until terminated or
modified by court order or until 180 days following the date of the
order, whichever event occurs earlier.
(i) Psychotropic medication or psychotropic drugs are those
medications administered for the purpose of affecting the central
nervous system to treat psychiatric disorders or illnesses. These
medications include, but are not limited to, anxiolytic agents,
antidepressants, mood stabilizers, antipsychotic medications,
anti-Parkinson agents, hypnotics, medications for dementia, and
psychostimulants.
(j) (1) Psychotropic medications may be administered without court
authorization to a child described in subdivision (a) in an
emergency. An emergency exists if all of the following conditions are
met:
(A) A physician finds that the child requires psychotropic
medication to treat a psychiatric disorder or illness.
(B) The medication is immediately necessary for the preservation
of life or the prevention of serious bodily harm to the child or
others. It is not necessary for the harm to take place or become
unavoidable prior to treatment.
(C) It is impractical to obtain authorization from the court
before administering the psychotropic medication to the child.
(2) Court authorization shall be sought as soon as practical, but
in no case more than two court days after the emergency
administration of psychotropic medication.
(k) This section is not intended to supersede local court rules
regarding a minor's right to participate in mental health decisions.
(l) This section does not grant any person the authority to
administer psychotropic medication to a child who indicates a refusal
of treatment with the authorized medication. A person shall not
threaten, coerce, withhold privileges, or otherwise penalize a child
for refusing to take a psychotropic medication. A child described in
subdivision (a) shall not be involuntarily administered a
psychotropic medication unless otherwise specifically permitted by
law.
(m) This section does not apply to nonminor dependents, as defined
in subdivision (v) of Section 11400.
(n) (1) On or before January 1, 2018, the Judicial Council shall
amend and adopt rules of court and develop appropriate forms for the
implementation of this section, in consultation with the State
Department of Social Services, the State Department of Health Care
Services, and stakeholders, including, but not limited to, the County
Welfare Directors Association of California, the County Behavioral
Health Directors Association of California, the Chief Probation
Officers of California, associations representing current and former
foster children, caregivers, and children's attorneys. This effort
shall be undertaken in coordination with the updates required under
paragraph (1) of subdivision (n) of Section 739.5.
(2) The rules of court and forms developed pursuant to paragraph
(1) shall address all of the following:
(A) The child and his or her caregiver and court-appointed special
advocate, if any, have an opportunity to provide input on the
medications being prescribed.
(B) Information regarding the child's overall mental health
assessment and treatment plan is provided to the court.
(C) Information regarding the rationale for the proposed
medication, provided in the context of past and current treatment
efforts, is provided to the court. This information shall include,
but not be limited to, information on other pharmacological and
nonpharmacological treatments that have been utilized and the child's
response to those treatments, a discussion of symptoms not
alleviated or ameliorated by other current or past treatment efforts,
and an explanation of how the psychotropic medication being
prescribed is expected to improve the child's symptoms.
(D) Guidance is provided to the court on how to evaluate the
request for authorization, including how to proceed if information,
otherwise required to be included in a request for authorization
under this section, is not included in a request for authorization
submitted to the court.
(3) The rules of
court and forms developed pursuant to paragraph (1) shall include a
process for periodic oversight by the court of orders regarding the
administration of psychotropic medications that includes the
caregiver's and child's observations regarding the effectiveness of
the medication and side effects, information on medication management
appointments and other followup appointments with medical
practitioners, and information on the delivery of other mental health
treatments that are a part of the child's overall treatment plan.
The periodic oversight shall be facilitated by the county social
worker, public health nurse, or other appropriate county staff. This
oversight process shall be conducted in conjunction with other
regularly scheduled court hearings and reports provided to the court
by the county child welfare agency.
(o) This section shall become operative on January 1, 2018.
SEC. 5. Section 739.5 of the Welfare and Institutions Code is
amended to read:
739.5. (a) (1) If a minor who has been adjudged a ward of the
court under Section 601 or 602 is removed from the physical custody
of the parent under Section 726 and placed into foster care, as
defined in Section 727.4, only a juvenile court judicial officer
shall have authority to make orders regarding the administration of
psychotropic medications for that minor. The juvenile court may issue
a specific order delegating this authority to a parent upon making
findings on the record that the parent poses no danger to the minor
and has the capacity to authorize psychotropic medications. Court
authorization for the administration of psychotropic medication shall
be based on a request from a physician, indicating the reasons for
the request, a description of the minor's diagnosis and behavior, the
expected results of the medication, and a description of any side
effects of the medication.
(2) (A) On or before July 1, 2016, the Judicial Council shall
amend and adopt rules of court and develop appropriate forms for the
implementation of this section, in consultation with the State
Department of Social Services, the State Department of Health Care
Services, and stakeholders, including, but not limited to, the County
Welfare Directors Association of California, the County Behavioral
Health Directors Association of California, the Chief Probation
Officers of California, associations representing current and former
foster children, caregivers, and minors' attorneys. This effort shall
be undertaken in coordination with the updates required under
paragraph (2) of subdivision (a) of Section 369.5.
(B) The rules of court and forms developed pursuant to
subparagraph (A) shall address all of the following:
(i) The minor and his or her caregiver and court-appointed special
advocate, if any, have an opportunity to provide input on the
medications being prescribed.
(ii) Information regarding the minor's overall mental health
assessment and treatment plan is provided to the court.
(iii) Information regarding the rationale for the proposed
medication, provided in the context of past and current treatment
efforts, is provided to the court. This information shall include,
but not be limited to, information on other pharmacological and
nonpharmacological treatments that have been utilized and the minor's
response to those treatments, a discussion of symptoms not
alleviated or ameliorated by other current or past treatment efforts,
and an explanation of how the psychotropic medication being
prescribed is expected to improve the minor's symptoms.
(iv) Guidance is provided to the court on how to evaluate the
request for authorization, including how to proceed if information,
otherwise required to be included in a request for authorization
under this section, is not included in a request for authorization
submitted to the court.
(C) The rules of court and forms developed pursuant to
subparagraph (A) shall include a process for periodic oversight by
the court of orders regarding the administration of psychotropic
medications that includes the caregiver's and minor's observations
regarding the effectiveness of the medication and side effects,
information on medication management appointments and other followup
appointments with medical practitioners, and information on the
delivery of other mental health treatments that are a part of the
minor's overall treatment plan. This oversight process shall be
conducted in conjunction with other regularly scheduled court
hearings and reports provided to the court by the county probation
agency.
(b) (1) The agency that completes the request for authorization
for the administration of psychotropic medication is encouraged to
complete the request within three business days of receipt from the
physician of the information necessary to fully complete the request.
(2) Nothing in this subdivision is intended to change current
local practice or local court rules with respect to the preparation
and submission of requests for authorization for the administration
of psychotropic medication.
(c) (1) Within seven court days from receipt by the court of a
completed request, the juvenile court judicial officer shall either
approve or deny in writing a request for authorization for the
administration of psychotropic medication to the minor, or shall,
upon a request by the parent, the legal guardian, or the minor's
attorney, or upon its own motion, set the matter for hearing.
(2) Notwithstanding Section 827 or any other law, upon the
approval or denial by the juvenile court judicial officer of a
request for authorization for the administration of psychotropic
medication, the county probation agency or other person or entity who
submitted the request shall provide a copy of the court order
approving or denying the request to the minor's caregiver.
(d) Psychotropic medication or psychotropic drugs are those
medications administered for the purpose of affecting the central
nervous system to treat psychiatric disorders or illnesses. These
medications include, but are not limited to, anxiolytic agents,
antidepressants, mood stabilizers, antipsychotic medications,
anti-Parkinson agents, hypnotics, medications for dementia, and
psychostimulants.
(e) Nothing in this section is intended to supersede local court
rules regarding a minor's right to participate in mental health
decisions.
(f) This section does not apply to nonminor dependents, as defined
in subdivision (v) of Section 11400.
(g) This section shall remain in effect only until January 1,
2018, and as of that date is repealed, unless a later enacted
statute, that is enacted before January 1, 2018, deletes or extends
that date.
SEC. 6. Section 739.5 is added to the Welfare and Institutions
Code, to read:
739.5. (a) If a minor who has been adjudged a ward of the court
under Section 601 or 602 is removed from the physical custody of the
parent under Section 726 and placed into foster care, as defined in
Section 727.4, only a juvenile court judicial officer shall have
authority to make orders regarding the administration of psychotropic
medications for that minor. The juvenile court may issue a specific
order delegating this authority to a parent, upon making findings on
the record that the parent poses no danger to the minor and has the
capacity to authorize psychotropic medications. Court authorization
for the administration of psychotropic medication shall be based on a
request from a physician, indicating the reasons for the request, a
description of the minor's diagnosis and behavior, the expected
results of the medication, and a description of any side effects of
the medication. If the court authorizes the administration of a
psychotropic medication, it shall verify that the administration of
the psychotropic medication is only one part of a comprehensive
treatment plan for the minor that shall include and specify the
psychosocial, behavioral, and alternative services, if any, the minor
will receive in addition to any authorized medication.
(b) (1) An order authorizing the administration of psychotropic
medications pursuant to this section shall be granted only upon the
court's determination that the administration of the medication is in
the best interest of the minor based on a determination that the
anticipated benefits of the psychotropic medication outweigh the
short- and long-term risks associated with the medications. An order
authorizing the administration of psychotropic medication pursuant to
this section shall not be granted if the court determines that the
medication is being used as punishment, for purposes other than the
treatment of a diagnosed mental health condition, as a substitute for
other less invasive treatments, or in quantities or dosages that
interfere with the minor's treatment program.
(2) An order authorizing the administration of psychotropic
medications pursuant to this section shall be granted only if the
court determines all of the following:
(A) The court is provided documentation confirming the minor's
caregiver has been informed, and the minor has been informed in an
age and developmentally appropriate manner in the primary language of
the minor, about the recommended medications, the anticipated
benefits, the nature, degree, duration, and probability of side
effects and significant risks commonly known by the medical
profession, and of psychosocial treatments and interventions specific
to the identified disorder and symptoms to be considered
concurrently with, or as an alternative to, the medication.
(i) The documentation shall state that the minor and the minor's
caregiver have been asked whether either have concerns regarding the
medication, and, if so, shall describe the nature of those concerns.
(ii) The documentation shall confirm that the minor has been
informed of the right to object to the authorization of psychotropic
medication and to request a hearing pursuant to paragraph (1) of
subdivision (g).
(iii) The documentation shall include the written consent or
refusal to consent of a minor who is 12 years of age or older.
(B) The prescribing physician submitting the request for
psychotropic medication was provided a copy of the child's health and
education summary or passport as described in Section 16010.
(C) The prescribing physician also confirms all of the following:
(i) There are no less invasive treatment options available to meet
the needs of the minor.
(ii) The dosage or dosage range requested is appropriate for the
minor.
(iii) The short- and long-term risks associated with the use of
psychotropic medications by the minor do not outweigh the reported
benefits to the minor.
(iv) All appropriate measurements have been completed and all
appropriate laboratory screenings or tests have been performed or
ordered for the child in accordance with accepted medical guidelines.
(D) A plan is in place for regular monitoring of the minor's
medication and psychosocial treatment plan, the effectiveness of the
medication and psychosocial treatment, and any potential side effects
of the medication by the physician in consultation with the
caregiver, mental health care provider, and others who have contact
with the minor, as appropriate.
(3) The person or entity submitting the request for authorization
of the administration of psychotropic medication is responsible for
providing the necessary documentation of the clinical appropriateness
of the proposed psychotropic medication and shall bear the burden of
proof.
(c) (1) A court shall not issue an order authorizing the
administration of psychotropic medications for a minor described in
subdivision (a) unless a preauthorization review is obtained from a
child psychiatrist or behavioral pediatrician, if one or more of the
following circumstances exist:
(A) The request is for any class of psychotropic medication for a
minor who is five years of age or younger.
(B) The request would result in the minor being administered three
or more psychotropic medications concurrently.
(C) The request is for the concurrent administration of two
antipsychotic medications unless the request is for medication
tapering and replacement that is limited to no more than 45 days.
(2) Preauthorization review under this subdivision does not
require a face-to-face assessment of the child for whom the
psychotropic medications are prescribed. The court, on its own motion
or upon the request of the child's attorney or the parent or parent'
s attorney, may order that assessment to be completed before deciding
whether or not to approve the request to authorize the medication.
The health care professional providing the preauthorization review
shall review all the information submitted to the court, including,
but not limited to, the prescribing physician's statement and the
child's health and education summary or passport, and, if deemed
necessary, conduct a telephone consultation with the prescriber or
the public health nurse responsible for the child pursuant to Section
16501.3.
(d) The court shall not authorize the administration of the
psychotropic medication for a minor described in subdivision (a)
unless the court is provided with documentation that appropriate
laboratory screenings, measurements, or tests for the minor have been
completed no more than 45 days prior to submission of the request to
the court in accordance with accepted medical guidelines.
(e) (1) No later than 60 days after the authorization of a new
psychotropic medication is granted or at the next review hearing
scheduled for a minor described in subdivision (a), if scheduled no
earlier than 45 days after the authorization of a new psychotropic
medication, the court shall conduct a review hearing to determine all
of the following:
(A) Whether the minor is taking the medication or medications.
(B) Whether psychosocial services and other aspects of the minor's
treatment plan have been provided to the minor.
(C) To what extent the symptoms for which the medication or
medications were authorized have been alleviated.
(D) Whether more time is needed to evaluate the effectiveness of
the medication or medications.
(E) What, if any, adverse effects the minor has suffered.
(F) Any steps taken to address those effects.
(G) The date or dates of followup visits with the prescribing
physician since the medication or medications were authorized.
(H) Whether the appropriate followup laboratory screenings have
been performed and their findings.
(2) Prior to the review, the minor's probation officer shall
submit a report to the court and to counsel for the parties, which
shall include information from the minor, the minor's caregiver, the
public health nurse, and the court-appointed special advocate, if
any.
(3) If, based upon this review, the court determines that the
proffered benefits of the medication have not been demonstrated or
that the risks of the medication outweigh the benefits, the court
shall reconsider, modify, or revoke its authorization for the
administration of medication.
(f) (1) The agency that completes the request for authorization
for the administration of psychotropic medication is encouraged to
complete the request within three business days of receipt from the
physician of the information necessary to fully complete the request.
(2) Nothing in this subdivision is intended to change current
local practice or local court rules with respect to the preparation
and submission of requests for authorization for the administration
of psychotropic medication.
(g) (1) Within seven court days from receipt by the court of a
completed request, the juvenile court judicial officer shall either
approve or deny in writing a request for authorization for the
administration of psychotropic medication to the minor, refer the
request for a preauthorization review as required by subdivision (c),
or shall, upon a request by the parent, the legal guardian, or the
minor's attorney, or upon its own motion, set the matter for hearing.
(2) Notwithstanding Section 827 or any other law, upon the
approval or denial by the juvenile court judicial officer of a
request for authorization for the administration of psychotropic
medication, the county probation agency or other person or entity who
submitted the request shall provide a copy of the court order
approving or denying the request to the minor's caregiver.
(h) If the court grants the request, or modifies and grants the
request, the order for authorization is effective until terminated or
modified by court order or until 180 days following the date of the
order, whichever event occurs earlier.
(i) Psychotropic medication or psychotropic drugs are those
medications administered for the purpose of affecting the central
nervous system to treat psychiatric disorders or illnesses. These
medications include, but are not limited to, anxiolytic agents,
antidepressants, mood stabilizers, antipsychotic medications,
anti-Parkinson agents, hypnotics, medications for dementia, and
psychostimulants.
(j) (1) Psychotropic medications may be administered without court
authorization to a minor described in subdivision (a) in an
emergency. An emergency exists if all of the following conditions are
met:
(A) A physician finds that the minor requires psychotropic
medication to treat a psychiatric disorder or illness.
(B) The medication is immediately necessary for the preservation
of life or the prevention of serious bodily harm to the minor or
others. It is not necessary for the harm to take place or become
unavoidable prior to treatment.
(C) It is impractical to obtain authorization from the court
before administering the psychotropic medication to the minor.
(2) Court authorization shall be sought as soon as practical, but
in no case more than two court days after the emergency
administration of psychotropic medication.
(k) This section is not intended to supersede local court rules
regarding a minor's right to participate in mental health decisions.
(l) This section does not grant any person the authority to
administer psychotropic medication to a minor who indicates a refusal
of treatment with the authorized medication. A person shall not
threaten, coerce, withhold privileges, or otherwise penalize a minor
for refusing to take a psychotropic medication. A minor described in
subdivision (a) shall not be involuntarily administered a
psychotropic medication unless otherwise specifically permitted by
law.
(m) This section does not apply to nonminor dependents, as defined
in subdivision (v) of Section 11400.
(n) (1) On or before January 1, 2018, the Judicial Council shall
amend and adopt rules of court and develop appropriate forms for the
implementation of this section, in consultation with the State
Department of Social Services, the State Department of Health Care
Services, and stakeholders, including, but not limited to, the County
Welfare Directors Association of California, the County Behavioral
Health Directors Association of California, the Chief Probation
Officers of California, associations representing current and former
foster children, caregivers, and minors' attorneys. This effort shall
be undertaken in coordination with the updates required under
paragraph (1) of subdivision (n) of Section 369.5.
(2) The rules of court and forms developed pursuant to paragraph
(1) shall address all of the following:
(A) The minor and his or her caregiver and court-appointed special
advocate, if any, have an opportunity to provide input on the
medications being prescribed.
(B) Information regarding the minor's overall mental health
assessment and treatment plan is provided to the court.
(C) Information regarding the rationale for the proposed
medication, provided in the context of past and current treatment
efforts, is provided to the court. This information shall include,
but not be limited to, information on other pharmacological and
nonpharmacological treatments that have been utilized and the minor's
response to those treatments, a discussion of symptoms not
alleviated or ameliorated by other current or past treatment efforts,
and an explanation of how the psychotropic medication being
prescribed is expected to improve the minor's symptoms.
(D) Guidance is provided to the court on how to evaluate the
request for authorization, including how to proceed if information,
otherwise required to be included in a request for authorization
under this section, is not included in a request for authorization
submitted to the court.
(3) The rules of court and forms developed pursuant to paragraph
(1) shall include a process for periodic oversight by the court of
orders regarding the administration of psychotropic medications that
includes the caregiver's and minor's observations regarding the
effectiveness of the medication and side effects, information on
medication management appointments and other followup appointments
with medical practitioners, and information on the delivery of other
mental health treatments that are a part of the minor's overall
treatment plan. This oversight process shall be conducted in
conjunction with other regularly scheduled court hearings and reports
provided to the court by the county probation agency.
(o) This section shall become operative on January 1, 2018.
SEC. 7. Section 1.5 of this bill incorporates amendments to
Section 4064.5 of the Business and Professions Code proposed by both
this bill and Senate Bill 999. It shall only become operative if (1)
both bills are enacted and become effective on or before January 1,
2017, (2) each bill amends Section 4064.5 of the Business and
Professions Code, and (3) this bill is enacted after Senate Bill 999,
in which case Section 1 of this bill shall not become operative.
SEC. 8. To the extent that this act has an overall effect of
increasing the costs already borne by a local agency for programs or
levels of service mandated by the 2011 Realignment Legislation within
the meaning of Section 36 of Article XIII of the California
Constitution, it shall apply to local agencies only to the extent
that the state provides annual funding for the cost increase. Any new
program or higher level of service provided by a local agency
pursuant to this act above the level for which funding has been
provided shall not require a subvention of funds by the state or
otherwise be subject to Section 6 of Article XIII B of the California
Constitution.
