Amended in Senate April 22, 2015

Amended in Senate March 23, 2015

Senate Bill No. 253

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 begin delete specified criteria are met, including end delete begin insert administration of the medication is in the best interest of the child and the court determines that specified requirements have been met, including end insert a requirement that the prescribing physician begin delete attest under penalty of perjury end delete begin insert confirms end insert 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.

begin delete

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.

end delete begin delete

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.

end delete begin delete

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

end delete

Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program:  begin delete yes end delete begin insert no 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, 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 begin delete of all of the following: end delete begin insert 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. end insert

begin insert

(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:

end insert

(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.

begin delete

(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.

end delete begin insert

(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.

end insert begin insert

(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).

end insert begin insert

(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.

end insert

(C) The prescribing physician submitting the request for
psychotropic medication begin delete attests under penalty of perjury end delete begin insert confirms end insert
that he or she conducted a comprehensive examination of the child
in compliance with Section 2242 of the Business and Professions
Code begin delete 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. end delete begin insert 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: end insert

begin insert

(i) The child’s trauma history.

end insert begin insert

(ii) The child’s medical records, including medication history.

end insert begin insert

(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.

end insert begin delete

(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.

end delete begin insert

(D) The prescribing physician shall also confirm all of the
following:

end insert begin insert

(i) There are no less invasive and effective treatment options
available to meet the needs of the child.

end insert begin insert

(ii) The dosage or dosage range requested is appropriate for
the child.

end insert begin insert

(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.

end insert begin insert

(iv) All appropriate lab screenings, measurements, or tests for
the child have been completed in accordance with accepted medical
guidelines.

end insert begin insert

(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.

end insert

(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 begin insert that is subject to a federal Food and Drug
Administration black box warning requirement or is for the
administration of an antipsychotropoic medication end insert 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 begin delete 45 end delete begin insert 60 end insert 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, begin delete whichever is earlier, end delete begin insert if scheduled no earlier than 45
days after the authorization of a new psychotropic medication, end insert the
court shall conduct a review hearing to determine all of the
following:

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

begin insert

(B) Whether psychosocial services and other aspects of the
child’s treatment plan have been provided to the child.

end insert begin delete

(B)

end delete

begin insert (C) end insert  To what extent the symptoms for which the medication or
medications were authorized have been alleviated.

begin delete

(C)

end delete

begin insert (D) end insert  What, if any, adverse effects the child has suffered.

begin delete

(D)

end delete

begin insert (E) end insert  Any steps taken to address those effects.

begin delete

(E)

end delete

begin insert (F) end insert  The date or dates of followup visits with the prescribing
physician since the medication or medications were authorized.

begin insert

(G) Whether the appropriate followup laboratory screenings
have been performed and their findings.

end insert

(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.

begin delete

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.

end delete