Bill Text: CA SB253 | 2015-2016 | Regular Session | Amended

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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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-Amended.html

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BILL NUMBER: SB 253	AMENDED
	BILL TEXT

	AMENDED IN SENATE  APRIL 22, 2015
	AMENDED IN SENATE  MARCH 23, 2015

INTRODUCED BY   Senator Monning
   (Principal coauthor: Assembly Member Chiu)
   (Coauthor: Senator Beall)
   (Coauthor: Assembly Member Gatto)

                        FEBRUARY 18, 2015

   An act to amend Section 369.5 of the Welfare and Institutions
Code, relating to juveniles.


	LEGISLATIVE COUNSEL'S DIGEST


   SB 253, as amended, Monning. Dependent children: psychotropic
medication.
   Existing law establishes the jurisdiction of the juvenile court,
which may adjudge children to be dependents of the court under
certain circumstances, including when the child suffered or there is
a substantial risk that the child will suffer serious physical harm,
or a parent fails to provide the child with adequate food, clothing,
shelter, or medical treatment. Existing law authorizes only a
juvenile court judicial officer to make orders regarding the
administration of psychotropic medications for a dependent child who
has been removed from the physical custody of his or her parent.
Existing law requires the 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.
   This bill would require that an order authorizing the
administration of psychotropic medications to a dependent child be
granted only upon the demonstration of clear and convincing evidence
that  specified criteria are met, including  
administration of the medication is in the best interest of the child
and the court determines that specified requirements have been met,
including  a requirement that the prescribing physician 
attest under penalty of perjury   confirms  that
he or she has conducted a comprehensive evaluation of the child, as
specified. The bill would prohibit the court from authorizing the
administration of psychotropic medications to a child under other
specified circumstances, unless a 2nd independent medical opinion is
obtained from a child psychiatrist or a psychopharmacologist. The
bill would prohibit the court from authorizing the administration of
a psychotropic medication unless the court is provided documentation
that appropriate screenings and tests for the child have been
completed no more than 30 days prior to submission of the request to
the court. 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 Judicial Council to adopt rules
to implement these provisions. 
   By requiring the attestation of the prescribing physician under
penalty of perjury, as described above, this bill would create a
crime and impose a state-mandated local program.  
   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. 
   Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program:  yes  no  .



THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

  SECTION 1.  Section 369.5 of the Welfare and Institutions Code is
amended to read:
   369.5.  (a) If a child is adjudged a dependent child of the court
under Section 300 and the child 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. On or before
July 1, 2016, the Judicial Council shall adopt rules of court and
develop appropriate forms for implementation of this section.
Whenever the court authorizes the administration of a psychotropic
medication, it shall ensure 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
services 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 only be granted on clear
and convincing evidence  of all of the following: 
 that 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.  
   (2) An order authorizing the administration of psychotropic
medications pursuant to this section shall only be granted if the
court determines all of the following: 
   (A) The medication is not being used as punishment, for the
convenience of staff, as a substitute for other, less invasive
treatments, or in quantities or dosages that interfere with the child'
s treatment program. 
   (B) If the child is 12 years of age or older, the child, after
being advised of alternative treatments and informed of the benefits
and risks of the medication, understands his or her right to refuse
the medication, and has given his or her written informed consent.
 
   (B) 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, 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 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.
The documentation shall confirm that the child has been informed of
the right to request a hearing pursuant to subdivision (g). 

   (ii) The documentation shall include the written informed consent
of a child who is 14 years of age or older, after being advised
pursuant to this subparagraph. 
   (C) The prescribing physician submitting the request for
psychotropic medication  attests under penalty of perjury
  confirms  that he or she conducted a
comprehensive examination of the child in compliance with Section
2242 of the Business and Professions Code  that takes into
account the child's trauma and medication history and is based upon
multiple sources, including, among others, the child's medical
records, the child, the child's parents, relatives, teacher,
caregiver or caregivers, past prescribers of psychotropic medication,
or other health care providers. The prescribing physician shall also
attest that the dosage or dosage range requested is appropriate for
the child.   and consistent with the Psychiatric
Evaluation and Diagnosis provisions included in the Guidelines for
the Use of Psychotropic Medication with Children and Youth in Foster
Care issued by the state, which takes into account all of the
following:  
   (i) The child's trauma history.  
   (ii) The child's medical records, including medication history.
 
   (iii) Multiple sources of information, including, but not limited
to, the child, the child's parents, relatives, teacher, caregiver or
caregivers, past prescribers of psychotropic medication, or other
health care providers.  
   (D) The short- and long-term risks associated with the use of
psychotropic medications by the child does not outweigh the reported
benefits to the child.  
   (E) There are no less invasive and effective treatment options
available to meet the needs of the child.  
   (D) The prescribing physician shall also confirm all of the
following:  
   (i) There are no less invasive and effective 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 does not outweigh the reported
benefits to the child.  
   (iv) All appropriate lab screenings, measurements, or tests for
the child have been completed in accordance with accepted medical
guidelines.  
   (E) 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. 
   (2) The person or entity submitting the request for authorization
of the administration of psychotropic medication shall bear the
burden of proof established in this section.
   (c) A court shall not issue an order authorizing the
administration of psychotropic medications for a child unless a
second independent medical opinion is obtained from a child
psychiatrist or a psychopharmacologist if one or more of the
following circumstances exist:
   (1) The request is for any class of psychotropic medication for a
child who is five years of age or younger.
   (2) The request would result in the child being administered three
or more psychotropic medications concurrently.
   (3) The request is for the concurrent administration of any two
drugs from the same class unless the request is for medication
tapering and replacement that is limited to no more than 30 days.
   (4) The request is for a dosage that exceeds the amount
recommended for children.
   (5) The request is for the administration of a psychotropic
medication  that is subject to a federal Food and Drug
Administration black box warning requirement or is for the
administration of an antipsychotropoic medication  for a use
that is not approved by the federal Food and Drug Administration for
children or adolescents.
   (d) The court shall not authorize the administration of the
psychotropic medication unless the court is provided documentation
that all of the appropriate lab screenings, measurements, or tests
for the child have been completed in accordance with accepted medical
guidelines no more than 30 days prior to submission of the request
to the court.
   (e) (1) No later than  45   60  days
after the authorization of a new psychotropic medication is granted
or at the next review hearing scheduled for the child pursuant to
Section 366, 366.21, 366.22, or 366.31,  whichever is
earlier,   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.  
   (B) 
    (C)  To what extent the symptoms for which the
medication or medications were authorized have been alleviated.

   (C) 
    (D)  What, if any, adverse effects the child has
suffered. 
   (D) 
    (E)  Any steps taken to address those effects. 
   (E) 
    (F)  The date or dates of followup visits with the
prescribing physician since the medication or medications were
authorized. 
   (G) Whether the appropriate followup laboratory screenings have
been performed and their findings. 
   (2) 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) 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.
   (h) 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.
   (i) Nothing in this section is intended to supersede local court
rules regarding a minor's right to participate in mental health
decisions.
   (j) This section shall not apply to nonminor dependents, as
defined in subdivision (v) of Section 11400. 
  SEC. 2.    No reimbursement is required by this
act pursuant to Section 6 of Article XIII B of the California
Constitution because the only costs that may be incurred by a local
agency or school district will be incurred because this act creates a
new crime or infraction, eliminates a crime or infraction, or
changes the penalty for a crime or infraction, within the meaning of
Section 17556 of the Government Code, or changes the definition of a
crime within the meaning of Section 6 of Article XIII B of the
California Constitution.