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

Senate BillNo. 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 addbegin delete Sectionend deletebegin insert Sectionsend insert 369.5begin insert and 739.5end insert 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. begin deleteDependent children: end deletebegin insertJuveniles: end insertpsychotropic medication.

Existing law establishes the jurisdiction of the juvenile court, which may adjudge children to be dependentsbegin insert or wardsend insert of the court under certainbegin delete 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.end deletebegin insert circumstances.end insert Existing law authorizes only a juvenile court judicial officer to make orders regarding the administration of psychotropic medications for a dependentbegin insert or delinquentend insert child who has been removed from the physical custody of his or her parent. Existing law requiresbegin delete theend deletebegin insert thatend insert 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 childbegin insert or a delinquent child in foster careend insert be granted only upon the court’s determination thatbegin delete there is clear and convincing evidence thatend deletebegin insert theend insert 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 2ndbegin delete independentend delete medical opinion is obtained frombegin delete a child psychiatrist or a behavioral pediatrician.end deletebegin insert an appropriately qualified health care professional.end insert 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 45 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 securingbegin delete 2nd review andend delete 2nd opinionsbegin insert in those counties in which there are fewer than 10 practicing child and adolescent psychiatristsend insert 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:

P3    1

SECTION 1.  

Section 4064.5 of the Business and Professions
2Code
is amended to read:

3

4064.5.  

(a) A pharmacist may dispense not more than a 90-day
4supply of a dangerous drug other than a controlled substance
5pursuant to a valid prescription that specifies an initial quantity of
6less than a 90-day supply followed by periodic refills of that
7amount if all of the following requirements are satisfied:

8(1) The patient has completed an initial 30-day supply of the
9dangerous drug.

10(2) The total quantity of dosage units dispensed does not exceed
11the total quantity of dosage units authorized by the prescriber on
12the prescription, including refills.

13(3) The prescriber has not specified on the prescription that
14dispensing the prescription in an initial amount followed by
15periodic refills is medically necessary.

16(4) The pharmacist is exercising his or her professional
17judgment.

18(b) For purposes of this section, if the prescription continues
19the same medication as previously dispensed in a 90-day supply,
20the initial 30-day supply under paragraph (1) of subdivision (a) is
21not required.

P4    1(c) A pharmacist dispensing an increased supply of a dangerous
2drug pursuant to this section shall notify the prescriber of the
3increase in the quantity of dosage units dispensed.

4(d) In no case shall a pharmacist dispense a greater supply of a
5dangerous drug pursuant to this section if the prescriber personally
6indicates, either orally or in his or her own handwriting, “No
7change to quantity,” or words of similar meaning. Nothing in this
8subdivision shall prohibit a prescriber from checking a box on a
9prescription marked “No change to quantity,” provided that the
10prescriber personally initials the box or checkmark. To indicate
11that an increased supply shall not be dispensed pursuant to this
12section for an electronic data transmission prescription as defined
13in subdivision (c) of Section 4040, a prescriber may indicate “No
14change to quantity,” or words of similar meaning, in the
15prescription as transmitted by electronic data, or may check a box
16marked on the prescription “No change to quantity.” In either
17instance, it shall not be required that the prohibition on an increased
18supply be manually initialed by the prescriber.

19(e) This section does not apply to psychotropic medication or
20psychotropic drugs as described inbegin delete Sectionend deletebegin insert Sectionsend insert 369.5begin insert andend insert
21begin insert 739.5end insert of the Welfare and Institutions Code.

22(f) Nothing in this section shall be construed to require a health
23care service plan, health insurer, workers’ compensation insurance
24plan, pharmacy benefits manager, or any other person or entity,
25including, but not limited to, a state program or state employer, to
26provide coverage for a dangerous drug in a manner inconsistent
27with a beneficiary’s plan benefit.

28

SEC. 2.  

Section 369.4 is added to the Welfare and Institutions
29Code
, to read:

30

369.4.  

The State Department of Health Care Services, in
31collaboration with the Judicial Council, shall identify resources,
32which may include, but need not be limited to, university-based
33consultation services, to assist the courts in securingbegin delete second review
34andend delete
second opinionsbegin insert in those counties in which there are fewer
35than 10 practicing child and adolescent psychiatristsend insert
in order to
36avoid undue delays in the authorization of medications pursuant
37tobegin delete Sectionend deletebegin insert Sectionsend insert 369.5begin insert and 739.5 of the Welfare and Institutions
38Codeend insert
.

39

SEC. 3.  

Section 369.5 of the Welfare and Institutions Code is
40amended to read:

P5    1

369.5.  

(a) If a child is adjudged a dependent child of the court
2under Section 300 and the child has been removed from the
3physical custody of the parent under Section 361, only a juvenile
4court judicial officer shall have authority to make orders regarding
5the administration of psychotropic medications for that child. The
6juvenile court may issue a specific order delegating this authority
7to a parent upon making findings on the record that the parent
8poses no danger to the child and has the capacity to authorize
9psychotropic medications. Court authorization for the
10administration of psychotropic medication shall be based on a
11request from a physician, indicating the reasons for the request, a
12description of the child’s diagnosis and behavior, the expected
13results of the medication, and a description of any side effects of
14the medication. On or before July 1, 2000, the Judicial Council
15shall adopt rules of court and develop appropriate forms for
16implementation of this section.

17(b) (1) In counties in which the county child welfare agency
18completes the request for authorization for the administration of
19psychotropic medication, the agency is encouraged to complete
20the request within three business days of receipt from the physician
21of the information necessary to fully complete the request.

22(2) Nothing in this subdivision is intended to change current
23local practice or local court rules with respect to the preparation
24and submission of requests for authorization for the administration
25of psychotropic medication.

26(c) Within seven court days from receipt by the court of a
27completed request, the juvenile court judicial officer shall either
28approve or deny in writing a request for authorization for the
29administration of psychotropic medication to the child, or shall,
30upon a request by the parent, the legal guardian, or the child’s
31attorney, or upon its own motion, set the matter for hearing.

32(d) Psychotropic medication or psychotropic drugs are those
33medications administered for the purpose of affecting the central
34nervous system to treat psychiatric disorders or illnesses. These
35medications include, but are not limited to, anxiolytic agents,
36antidepressants, mood stabilizers, antipsychotic medications,
37anti-Parkinson agents, hypnotics, medications for dementia, and
38psychostimulants.

P6    1(e) Nothing in this section is intended to supersede local court
2rules regarding a minor’s right to participate in mental health
3decisions.

4(f) This section shall not apply to nonminor dependents, as
5defined in subdivision (v) of Section 11400.

6(g) This section shallbegin delete remain in effect only untilend deletebegin insert become
7inoperative onend insert
July 1, 2016, and as of January 1, 2017, is repealed,
8unless a later enacted statute, that is enacted before January 1,
92017, deletes or extends that date.

10

SEC. 4.  

Section 369.5 is added to the Welfare and Institutions
11Code
, to read:

12

369.5.  

(a) If a child is adjudged a dependent child of the court
13under Section 300 and the child has been removed from the
14physical custody of the parent under Section 361, only a juvenile
15court judicial officer shall have authority to make orders regarding
16the administration of psychotropic medications for that child. The
17juvenile court may issue a specific order delegating this authority
18to a parent, upon making findings on the record that the parent
19poses no danger to the child and has the capacity to authorize
20psychotropic medications. Court authorization for the
21administration of psychotropic medication shall be based on a
22request from a physician, indicating the reasons for the request, a
23description of the child’s diagnosis and behavior, the expected
24results of the medication, and a description of any side effects of
25the medication. On or before July 1, 2016, the Judicial Council
26shall adopt rules of court and develop appropriate forms for
27implementation of this section.begin delete Wheneverend deletebegin insert Ifend insert the court authorizes
28the administration of a psychotropic medication, it shallbegin delete ensureend delete
29begin insert verifyend insert that the administration of the psychotropic medication is
30only one part of a comprehensive treatment plan for the child that
31shall include and specify the psychosocial, behavioral, and
32alternative services, if any, the child will receive in addition to any
33authorized medication.

34(b) (1) An order authorizing the administration of psychotropic
35medications pursuant to this section shall be granted only upon
36the court’s determination that begin delete there is clear and convincing
37evidence thatend delete
begin insert theend insert administration of the medication is in the best
38interest of the child based on a determination that the anticipated
39benefits of the psychotropic medication outweigh the short- and
40long-term risks associated with the medications. An order
P7    1authorizing the administration of psychotropic medication pursuant
2to this section shall not be granted if the court determines that the
3medication is being used as punishment,begin delete for the convenience of
4staff,end delete
begin insert for purposes other than the treatment of a diagnosed mental
5health condition,end insert
as a substitute for other less invasive treatments,
6or in quantities or dosages that interfere with the child’s treatment
7program.

8(2) An order authorizing the administration of psychotropic
9medications pursuant to this section shall be granted only if the
10court determines all of the following:

11(A) The court is provided documentation confirming the child’s
12caregiver has been informed, and the child has been informed in
13an age and developmentally appropriate manner in the primary
14language of the child, about the recommended medications, the
15anticipated benefits, the nature, degree, duration, and probability
16of side effects and significant risks commonly known by the
17medical profession, and of psychosocial treatments and
18interventions specific to the identified disorder and symptoms to
19be considered concurrently with or as an alternative to the
20medication.

21(i) The documentation shall state that the child and the child’s
22caregiver have been asked whether either have concerns regarding
23the medication, and if so, shall describe the nature of those
24concerns.

25(ii) The documentation shall confirm that the child has been
26informed of the right to object to the authorization of psychotropic
27medication and to request a hearing pursuant to subdivision (g).

28(iii) The documentation shall include the written assent or refusal
29to assent of a child who is 12 years of age or older.

30(B) The prescribing physician submitting the request for
31psychotropic medication has conducted a comprehensive
32examination of the childbegin delete in complianceend deletebegin insert that compliesend insert with Section
332242 of the Business and Professions Code andbegin delete consistent with
34the Psychiatric Evaluation and Diagnosis provisions included in
35the Guidelines for the Use of Psychotropic Medication with
36Children and Youth in Foster Care issued by the state, whichend delete
begin insert thatend insert
37 takes into account all of the following:

38(i) The child’s trauma history.

39(ii) The child’s health care history, including medication history.

P8    1(iii) begin deleteMultiple sources of information, end deletebegin insertInformation from multiple
2sources end insert
that should include, but are not limited to, the child, the
3child’s parents, relatives, teacher, caregiver or caregivers, past
4prescribers of psychotropic medication, or other health care
5providers.

6(C) The prescribing physician also confirms all of the following:

7(i) There are no less invasive treatment options available to meet
8the needs of the child.

9(ii) The dosage or dosage range requested is appropriate for the
10child.

11(iii) The short- and long-term risks associated with the use of
12psychotropic medications by the child does not outweigh the
13reported benefits to the child.

14(iv) All appropriate laboratory screenings, measurements, or
15tests for the child have been completed in accordance with accepted
16medical guidelines.

17(D) A plan is in place for regular monitoring of the child’s
18medication and psychosocial treatment plan, the effectiveness of
19the medication and psychosocial treatment, and any potential side
20effects of the medication, by the physician in consultation with
21the caregiver, mental health care provider, and others who have
22contact with the child, as appropriate.

23(3) The person or entity submitting the request for authorization
24of the administration of psychotropic medication is responsible
25for providing the necessary documentation of the clinical
26appropriateness of the proposed psychotropic medication and shall
27bear the burden ofbegin delete proof established in this section.end deletebegin insert proof.end insert

28(c) A court shall not issue an order authorizing the administration
29of psychotropic medications for a childbegin insert described in subdivision
30(a)end insert
unless a secondbegin delete independentend delete medical opinion is obtained from
31begin delete a child psychiatrist or a behavioral pediatricianend deletebegin insert an appropriately
32qualified health care professional, as defined in subdivision (b)
33of Section 1383.15 of the Health and Safety Code,end insert
if one or more
34of the following circumstances exist:

35(1) The request is for any class of psychotropic medication for
36a child who is five years of age or younger.

37(2) The request would result in the child being administered
38three or more psychotropic medications concurrently.

39(3) The request is for the concurrent administration of begin delete any two
40drugs from the same classend delete
begin insert two antipsychotic medicationsend insert unless
P9    1the request is for medication tapering and replacement that is
2limited to no more than 45 days.

begin delete

3(4) The request is for a dosage that exceeds the amount
4recommended for children.

end delete

5(d) The court shall not authorize the administration of the
6psychotropic medicationbegin insert for a child described in subdivision (a)end insert
7 unless the court is provided with documentation thatbegin delete all of theend delete
8 appropriate laboratory screenings, measurements, or tests for the
9child have been completed no more than 45 days prior to
10submission of the request to the court in accordance with accepted
11medical guidelines.

12(e) (1) No later than 60 days after the authorization of a new
13psychotropic medication is granted or at the next review hearing
14scheduled forbegin delete the child,end deletebegin insert a child described in subdivision (a),end insert if
15scheduled no earlier than 45 days after the authorization of a new
16psychotropic medication, the court shall conduct a review hearing
17to determine all of the following:

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

19(B) Whether psychosocial services and other aspects of the
20child’s treatment plan have been provided to the child.

21(C) To what extent the symptoms for which the medication or
22medications were authorized have been alleviated.

23(D) Whether more time is needed to evaluate the effectiveness
24of the medication or medications.

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

26(F) Any steps taken to address those effects.

27(G) The date or dates of followup visits with the prescribing
28physician since the medication or medications were authorized.

29(H) Whether the appropriate followup laboratory screenings
30have been performed and their findings.

31(2) Prior to the review, the child’s social worker shall submit a
32report to the court and to counsel for the parties, which shall
33include information from the child, the child’s caregiver, the public
34health nurse, and the court appointed special advocate, if any.

35(3) If based upon this review, the court determines that the
36proffered benefits of the medication have not been demonstrated
37or that the risks of the medication outweigh the benefits, the court
38shall reconsider, modify, or revoke its authorization for the
39administration of medication.

P10   1(f) (1) In counties in which the county child welfare agency
2completes the request for authorization for the administration of
3psychotropic medication, the agency is encouraged to complete
4the request within three business days of receipt from the physician
5of the information necessary to fully complete the request.

6(2) This subdivision is not intended to change current local
7practice or local court rules with respect to the preparation and
8submission of requests for authorization for the administration of
9 psychotropic medication.

10(g) Within seven court days from receipt by the court of a
11completed request, the juvenile court judicial officer shall either
12approve or deny in writing a request for authorization for the
13administration of psychotropic medication to the child, refer the
14request for a second opinion as required by subdivision (c), or
15shall, upon a request by the parent, the legal guardian, or the child’s
16attorney, or upon its own motion, set the matter for hearing.

17(h) If the court grants the request, or modifies andbegin delete thenend delete grants
18the request, the order for authorization is effective until terminated
19or modified by court order or until 180 days following the date of
20the order, whicheverbegin delete isend deletebegin insert date occursend insert earlier.

21(i) Psychotropic medication or psychotropic drugs are those
22medications administered for the purpose of affecting the central
23nervous system to treat psychiatric disorders or illnesses. These
24medications include, but are not limited to, anxiolytic agents,
25antidepressants, mood stabilizers, antipsychotic medications,
26anti-Parkinson agents, hypnotics, medications for dementia, and
27psychostimulants.

28(j) (1) Psychotropic medications may be administered without
29court authorizationbegin insert to a child described in subdivision (a)end insert in an
30emergency. An emergency exists if all of the following conditions
31are met:

32(A) A physician finds that the child requires psychotropic
33medication to treat a psychiatric disorder or illness.

34(B) The medication is immediately necessary for the
35preservation of life or the prevention of serious bodily harm to the
36child or others. It is not necessary for the harm to take place or
37become unavoidable prior to treatment.

38(C) It is impractical to obtain authorization from the court before
39administering the psychotropic medication to the child.

P11   1(2) Court authorization shall be sought as soon as practical, but
2in no case more than two court days after the emergency
3administration of psychotropic medication.

4(k) This section is not intended to supersede local court rules
5regarding a minor’s right to participate in mental health decisions.

6(l) begin deleteNothing in this section grants end deletebegin insertThis section does not grant end insert
7any person the authority to administer psychotropic medication to
8a child whobegin delete orally refused or otherwiseend delete indicates a refusal of
9treatment with the authorized medication.begin delete A child’s objection to
10or noncompliance with, the authorized psychotropic medication
11is a treatment issue to be resolved by the physician prescribing the
12medication. No end delete
begin insert A end insertperson shallbegin insert notend insert threaten, coerce, withhold
13privileges, or otherwise penalize a child for refusing to take a
14psychotropic medication. A childbegin delete cannot be forced to takeend delete
15begin insert described in subdivision (a) shall not be involuntarily administered
16aend insert
psychotropic medication unless otherwise specifically permitted
17by statute.

18(m) This section shall not apply to nonminor dependents, as
19defined in subdivision (v) of Section 11400.

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

21begin insert

begin insertSEC. 5.end insert  

end insert

begin insertSection 739.5 of the end insertbegin insertWelfare and Institutions Codeend insertbegin insert is
22amended to read:end insert

23

739.5.  

(a) If a minor who has been adjudged a ward of the
24court under Section 601 or 602 is removed from the physical
25custody of the parent under Section 726 and placed into foster
26care, as defined in Section 727.4, only a juvenile court judicial
27officer shall have authority to make orders regarding the
28administration of psychotropic medications for that minor. The
29juvenile court may issue a specific order delegating this authority
30to a parent upon making findings on the record that the parent
31poses no danger to the minor and has the capacity to authorize
32psychotropic medications. Court authorization for the
33administration of psychotropic medication shall be based on a
34request from a physician, indicating the reasons for the request, a
35description of the minor’s diagnosis and behavior, the expected
36results of the medication, and a description of any side effects of
37the medication. On or before July 1, 2008, the Judicial Council
38shall adopt rules of court and develop appropriate forms for
39implementation of this section.

P12   1(b) (1) The agency that completes the request for authorization
2for the administration of psychotropic medication is encouraged
3to complete the request within three business days of receipt from
4the physician of the information necessary to fully complete the
5request.

6(2) Nothing in this subdivision is intended to change current
7local practice or local court rules with respect to the preparation
8and submission of requests for authorization for the administration
9of psychotropic medication.

10(c) Within seven court days from receipt by the court of a
11completed request, the juvenile court judicial officer shall either
12approve or deny in writing a request for authorization for the
13administration of psychotropic medication to the minor, or shall,
14upon a request by the parent, the legal guardian, or the minor’s
15attorney, or upon its own motion, set the matter for hearing.

16(d) Psychotropic medication or psychotropic drugs are those
17medications administered for the purpose of affecting the central
18nervous system to treat psychiatric disorders or illnesses. These
19medications include, but are not limited to, anxiolytic agents,
20antidepressants, mood stabilizers, antipsychotic medications,
21anti-Parkinson agents, hypnotics, medications for dementia, and
22psychostimulants.

23(e) Nothing in this section is intended to supersede local court
24rules regarding a minor’s right to participate in mental health
25decisions.

begin insert

26(f) This section shall become inoperative on July 1, 2016, and
27as of January 1, 2017, is repealed, unless a later enacted statute,
28that is enacted before January 1, 2017, deletes or extends that
29date.

end insert
30begin insert

begin insertSEC. 6.end insert  

end insert

begin insertSection 739.5 is added to the end insertbegin insertWelfare and Institutions
31Code
end insert
begin insert, to read:end insert

begin insert
32

begin insert739.5.end insert  

(a) If a minor who has been adjudged a ward of the
33court under Section 601 or 602 is removed from the physical
34custody of the parent under Section 726 and placed into foster
35care, as defined in Section 727.4, only a juvenile court judicial
36officer shall have authority to make orders regarding the
37administration of psychotropic medications for that minor. The
38juvenile court may issue a specific order delegating this authority
39to a parent, upon making findings on the record that the parent
40poses no danger to the minor and has the capacity to authorize
P13   1psychotropic medications. Court authorization for the
2administration of psychotropic medication shall be based on a
3request from a physician, indicating the reasons for the request,
4a description of the minor’s diagnosis and behavior, the expected
5results of the medication, and a description of any side effects of
6the medication. On or before July 1, 2016, the Judicial Council
7shall adopt rules of court and develop appropriate forms for
8implementation of this section. If the court authorizes the
9administration of a psychotropic medication, it shall verify that
10the administration of the psychotropic medication is only one part
11of a comprehensive treatment plan for the minor that shall include
12and specify the psychosocial, behavioral, and alternative services,
13if any, the minor will receive in addition to any authorized
14medication.

15(b) (1) An order authorizing the administration of psychotropic
16medications pursuant to this section shall be granted only upon
17the court’s determination that the administration of the medication
18is in the best interest of the minor based on a determination that
19the anticipated benefits of the psychotropic medication outweigh
20the short- and long-term risks associated with the medications. An
21order authorizing the administration of psychotropic medication
22pursuant to this section shall not be granted if the court determines
23that the medication is being used as punishment, for purposes
24other than the treatment of a diagnosed mental health condition,
25as a substitute for other less invasive treatments, or in quantities
26or dosages that interfere with the minor’s treatment program.

27(2) An order authorizing the administration of psychotropic
28medications pursuant to this section shall be granted only if the
29court determines all of the following:

30(A) The court is provided documentation confirming the minor’s
31caregiver has been informed, and the minor has been informed in
32an age and developmentally appropriate manner in the primary
33language of the minor, about the recommended medications, the
34anticipated benefits, the nature, degree, duration, and probability
35of side effects and significant risks commonly known by the medical
36profession, and of psychosocial treatments and interventions
37specific to the identified disorder and symptoms to be considered
38concurrently with, or as an alternative to, the medication.

39(i) The documentation shall state that the minor and the minor’s
40caregiver have been asked whether either have concerns regarding
P14   1the medication, and if so, shall describe the nature of those
2concerns.

3(ii) The documentation shall confirm that the minor has been
4informed of the right to object to the authorization of psychotropic
5medication and to request a hearing pursuant to subdivision (g).

6(iii) The documentation shall include the written assent or
7refusal to assent of a minor who is 12 years of age or older.

8(B) The prescribing physician submitting the request for
9psychotropic medication has conducted a comprehensive
10examination of the minor that complies with Section 2242 of the
11Business and Professions Code and that takes into account all of
12the following:

13(i) The minor’s trauma history.

14(ii) The minor’s health care history, including medication
15history.

16(iii) Information from multiple sources that should include, but
17are not limited to, the minor, the minor’s parents, relatives,
18teacher, caregiver or caregivers, past prescribers of psychotropic
19medication, or other health care providers.

20(C) The prescribing physician also confirms all of the following:

21(i) There are no less invasive treatment options available to
22meet the needs of the minor.

23(ii) The dosage or dosage range requested is appropriate for
24the minor.

25(iii) The short- and long-term risks associated with the use of
26psychotropic medications by the minor does not outweigh the
27reported benefits to the minor.

28(iv) All appropriate laboratory screenings, measurements, or
29tests for the minor have been completed in accordance with
30accepted medical guidelines.

31(D) A plan is in place for regular monitoring of the minor’s
32medication and psychosocial treatment plan, the effectiveness of
33the medication and psychosocial treatment, and any potential side
34effects of the medication by the physician in consultation with the
35caregiver, mental health care provider, and others who have
36contact with the minor, as appropriate.

37(3) The person or entity submitting the request for authorization
38of the administration of psychotropic medication is responsible
39for providing the necessary documentation of the clinical
P15   1appropriateness of the proposed psychotropic medication and
2shall bear the burden of proof.

3(c) A court shall not issue an order authorizing the
4administration of psychotropic medications for a minor described
5in subdivision (a) unless a second medical opinion is obtained
6from an appropriately qualified health care professional, as defined
7in subdivision (b) of Section 1383.15 of the Health and Safety
8Code, if one or more of the following circumstances exist:

9(1) The request is for any class of psychotropic medication for
10a minor who is five years of age or younger.

11(2) The request would result in the minor being administered
12three or more psychotropic medications concurrently.

13(3) The request is for the concurrent administration of two
14antipsychotic medications unless the request is for medication
15tapering and replacement that is limited to no more than 45 days.

16(d) The court shall not authorize the administration of the
17psychotropic medication for a minor described in subdivision (a)
18unless the court is provided with documentation that appropriate
19laboratory screenings, measurements, or tests for the minor have
20been completed no more than 45 days prior to submission of the
21request to the court in accordance with accepted medical
22guidelines.

23(e) (1) No later than 60 days after the authorization of a new
24psychotropic medication is granted or at the next review hearing
25scheduled for a minor described in subdivision (a), if scheduled
26no earlier than 45 days after the authorization of a new
27psychotropic medication, the court shall conduct a review hearing
28to determine all of the following:

29(A) Whether the minor is taking the medication or medications.

30(B) Whether psychosocial services and other aspects of the
31minor’s treatment plan have been provided to the minor.

32(C) To what extent the symptoms for which the medication or
33medications were authorized have been alleviated.

34(D) Whether more time is needed to evaluate the effectiveness
35of the medication or medications.

36(E) What, if any, adverse effects the minor has suffered.

37(F) Any steps taken to address those effects.

38(G) The date or dates of followup visits with the prescribing
39physician since the medication or medications were authorized.

P16   1(H) Whether the appropriate followup laboratory screenings
2have been performed and their findings.

3(2) Prior to the review, the minor’s probation officer shall
4submit a report to the court and to counsel for the parties, which
5shall include information from the minor, the minor’s caregiver,
6the public health nurse, and the court appointed special advocate,
7if any.

8(3) If based upon this review, the court determines that the
9proffered benefits of the medication have not been demonstrated
10or that the risks of the medication outweigh the benefits, the court
11shall reconsider, modify, or revoke its authorization for the
12administration of medication.

13(f) (1) The agency that completes the request for authorization
14for the administration of psychotropic medication is encouraged
15to complete the request within three business days of receipt from
16the physician of the information necessary to fully complete the
17request.

18(2) Nothing in this section is intended to change current local
19practice or local court rules with respect to the preparation and
20submission of requests for authorization for the administration of
21psychotropic medication.

22(g) Within seven court days from receipt by the court of a
23completed request, the juvenile court judicial officer shall either
24approve or deny in writing a request for authorization for the
25administration of psychotropic medication to the minor, refer the
26request for a second opinion as required by subdivision (c), or
27shall, upon a request by the parent, the legal guardian, or the
28minor’s attorney, or upon its own motion, set the matter for
29hearing.

30(h) If the court grants the request, or modifies and grants the
31request, the order for authorization is effective until terminated
32or modified by court order or until 180 days following the date of
33the order, whichever is earlier.

34(i) Psychotropic medication or psychotropic drugs are those
35medications administered for the purpose of affecting the central
36nervous system to treat psychiatric disorders or illnesses. These
37medications include, but are not limited to, anxiolytic agents,
38 antidepressants, mood stabilizers, antipsychotic medications,
39anti-Parkinson agents, hypnotics, medications for dementia, and
40psychostimulants.

P17   1(j) (1) Psychotropic medications may be administered without
2court authorization to a minor described in subdivision (a) in an
3emergency. An emergency exists if all of the following conditions
4are met:

5(A) A physician finds that the minor requires psychotropic
6medication to treat a psychiatric disorder or illness.

7(B) The medication is immediately necessary for the preservation
8of life or the prevention of serious bodily harm to the minor or
9others. It is not necessary for the harm to take place or become
10unavoidable prior to treatment.

11(C) It is impractical to obtain authorization from the court
12before administering the psychotropic medication to the minor.

13(2) Court authorization shall be sought as soon as practical,
14but in no case more than two court days after the emergency
15administration of psychotropic medication.

16(k) This section is not intended to supersede local court rules
17regarding a minor’s right to participate in mental health decisions.

18(l) This section does not grant any person the authority to
19administer psychotropic medication to a minor who indicates a
20refusal of treatment with the authorized medication. A person shall
21not threaten, coerce, withhold privileges, or otherwise penalize a
22minor for refusing to take a psychotropic medication. A minor
23described in subdivision (a) shall not be involuntarily administered
24a psychotropic medication unless otherwise specifically permitted
25by statute.

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

end insert
27

begin deleteSEC. 5.end delete
28begin insertSEC. 7.end insert  

If the Commission on State Mandates determines that
29this act contains costs mandated by the state, reimbursement to
30local agencies and school districts for those costs shall be made
31pursuant to Part 7 (commencing with Section 17500) of Division
324 of Title 2 of the Government Code.



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