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

Senate Bill No. 253

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 Section 369.5 of, and to add Section 369.4 to, 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, commencing July 1, 2016, would require that an order authorizing the administration of psychotropic medications to a dependent child be granted only upon the court’s determination that there is clear and convincing evidence that 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 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 behavioral pediatrician. The bill would prohibit the court from authorizing the administration of a psychotropic medication unless the court is provided documentation that appropriate laboratory screenings and tests for the child have been completed no more than begin delete 30 end delete begin insert 45 end insert 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 child’s social worker to submit a report to the court prior to the 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, this bill would create 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, 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 to implement these provisions.

This bill would require the State Department of Health Care Services, in collaboration with the Judicial Council, to identify resources to assist courts in securing 2nd review and 2nd opinions in order to avoid undue delays in the authorization of psychotropic medications.

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, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to these statutory provisions.

Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: yes.

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 Section 369.5 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. 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 second review
and second opinions in order to avoid undue delays in the
authorization of medications pursuant to Section 369.5.

SEC. 3.  

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, 2000, the Judicial Council
shall adopt rules of court and develop appropriate forms for
implementation of this section.

(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) 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.

(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 shall not apply to nonminor dependents, as
defined in subdivision (v) of Section 11400.

(g) This section shall remain in effect only until July 1, 2016,
and as of January 1, 2017, is repealed, unless a later enacted statute,
that is enacted before January 1, 2017, 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 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, 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 there is clear and convincing
evidence 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. 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 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.

(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 subdivision (g).

(iii) The documentation shall include the written assent or refusal
to assent of a child who is 12 years of age or older.

(B) The prescribing physician submitting the request for
psychotropic medication has conducted a comprehensive
examination of the child in compliance with Section 2242 of the
Business and Professions Code 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 health care history, including medication history.

(iii) Multiple sources of information, that should include, but
are not limited to, the child, the child’s parents, relatives, teacher,
caregiver or caregivers, past prescribers of psychotropic
medication, or other health care providers.

(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 does not outweigh the
reported benefits to the child.

(iv) All appropriate laboratory screenings, measurements, or
tests for the child have been completed 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 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 behavioral pediatrician 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 begin delete 30 end delete begin insert 45 end insert
days.

(4) The request is for a dosage that exceeds the amount
recommended for children.

(d) The court shall not authorize the administration of the
psychotropic medication unless the court is provided with
documentation that all of the appropriate laboratory screenings,
measurements, or tests for the child have been completed no more
than begin delete 30 end delete begin insert 45 end insert 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 the child, 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) This subdivision is not 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, refer the
request for a second opinion 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.

(h) If the court grants the request, or modifies and then 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 is 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 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) Nothing in this section grants any person the authority to
administer psychotropic medication to a child who orally refused
or otherwise indicates a refusal of treatment with the authorized
medication. A child’s objection to or noncompliance with, the
authorized psychotropic medication is a treatment issue to be
resolved by the physician prescribing the medication. No person
shall threaten, coerce, withhold privileges, or otherwise penalize
a child for refusing to take a psychotropic medication. A child
cannot be forced to take psychotropic medication unless otherwise
specifically permitted by statute.

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

(n) This section shall become operative on July 1, 2016.

SEC. 5.  

If the Commission on State Mandates determines that
this act contains costs mandated by the state, reimbursement to
local agencies and school districts for those costs shall be made
pursuant to Part 7 (commencing with Section 17500) of Division
4 of Title 2 of the Government Code.