Amended in Senate March 23, 2015

Senate Bill No. 253

Introduced by Senator Monning

(Principal coauthor: Assembly Member Chiu)

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(Coauthor: Senator Beall)

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(Coauthor: Assembly Member Gatto)

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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 begin insert a child end insert 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 begin insert that end insert an order authorizing begin insert the end insert administration of psychotropic medications to begin delete only end delete begin insert a dependent child end insert be granted begin delete on end delete begin insert only upon the demonstration of end insert clear and convincing evidence begin delete of end delete begin insert that end insert specified begin delete matters, and end delete begin insert criteria are met, including a requirement that the prescribing physician attest under penalty of perjury that he or she has conducted a comprehensive evaluation of the child, as specified. The bill end insert would prohibit the court from authorizing the administration of psychotropic medications begin delete for end delete begin insert to end insert a child begin insert under other specified circumstances, end insert unless a 2nd independent medical opinion is obtained from a child psychiatrist or a begin delete psychopharmacologist if one or more specified circumstances exist, including if the request is for any class of psychotropic medication for a child who is 5 years of age or younger. end delete begin insert psychopharmacologist. end insert 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. begin insert 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. end insert

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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.

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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.

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This bill would provide that no reimbursement is required by this act for a specified reason.

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Vote: majority. Appropriation: no. Fiscal committee:  begin delete no end delete begin insert yes end insert . State-mandated local program:  begin delete no end delete begin insert yes end insert .

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, begin delete 2000, end delete begin insert 2016, end insert the Judicial
Council shall adopt rules of court and develop appropriate forms
for implementation of this section. begin insert Whenever the court authorizes
the administration of a psychotropic medication, it shall ensure
that the administration of the end insert begin insert 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. end insert

(b)  begin insert (1) end insert begin insert   end insert 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:

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(1)

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begin insert (A) end insert  The medication is not being used as begin delete a chemical restraint. end delete
begin insert 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. end insert

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(2)

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begin insert (B) end insert  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, begin insert understands his or her right to refuse the
medication, and end insert has given his or her begin insert written end insert informed consent.

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(3)

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begin insert (C) end insert  The prescribing physician submitting the request for
psychotropic medication begin insert attests under penalty of perjury that he
or she end insert 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 begin delete history. end delete begin insert 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. end insert

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(4) The prescribed dosage is appropriate for the child’s age.

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(5)

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begin insert (D) end insert  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.

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(6)

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begin insert (E) end insert  There are no less invasive begin insert and effective end insert treatment options
available begin delete other than the administration of psychotropic medications. end delete
begin insert to meet the needs of the child. end insert

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(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.

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(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
begin delete multiple end delete begin insert three or more end insert 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.

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(5) The request is for the administration of a psychotropic
medication for a use that is not approved by the federal Food and
Drug Administration for children or adolescents.

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(d) The court shall not authorize the administration of the
psychotropic medication unless the court is provided
documentation begin insert that end insert all begin insert of end insert the appropriate lab screenings,
measurements, or tests for the child have been completed in
accordance with begin delete the end delete accepted medical guidelines no more than 30
days prior to submission of the request to the court.

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(e) (1) No later than 45 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, the court shall conduct a review
hearing to determine all of the following:

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(A) Whether the child is taking the medication or medications.

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(B) To what extent the symptoms for which the medication or
medications were authorized have been alleviated.

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(C) What, if any, adverse effects the child has suffered.

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(D) Any steps taken to address those effects.

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(E) The date or dates of follow-up visits with the prescribing
physician since the medication or medications were authorized.

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(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.

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(e)

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begin insert (f) end insert  (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.

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(f)

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begin insert (g) end insert  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.

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(g)

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begin insert (h) end insert  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.

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(h)

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begin insert (i) end insert  Nothing in this section is intended to supersede local court
rules regarding a minor’s right to participate in mental health
decisions.

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(i)

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begin insert (j) end insert  This section shall not apply to nonminor dependents, as
defined in subdivision (v) of Section 11400.

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begin insert SEC. 2. end insert   

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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.

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