Amended in Assembly August 4, 2016

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 add Sections 369.5 and 739.5 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. Juveniles: psychotropic medication.

Existing law establishes the jurisdiction of the juvenile court, which may adjudge children to be dependents or wards of the court under certain circumstances. Existing law authorizes only a juvenile court judicial officer to make orders regarding the administration of psychotropic medications for a dependent or delinquent child who has been removed from the physical custody of his or her parent. Existing law requires that 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.begin insert Existing law requires the Judicial Council to adopt rules of court and develop appropriate forms for the implementation of these provisions, as specified.end insert

This bill, commencingbegin delete July 1, 2016,end deletebegin insert January 1, 2018,end insert would require that an order authorizing the administration of psychotropic medications to a dependent child or a delinquent child in foster care be granted only upon the court’s determination that the 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 thatbegin delete he or she has conducted a comprehensive evaluation ofend deletebegin insert all appropriate laboratory screenings or tests have been performed or ordered forend insert the child, as specified.begin delete Theend deletebegin insert Under specified circumstances, theend insert bill would prohibit the court from authorizing the administration of psychotropic medications to a child underbegin delete other specified circumstances,end deletebegin insert those provisions,end insert unless abegin delete 2nd medical opinionend deletebegin insert preauthorization reviewend insert is obtained frombegin delete an appropriately qualified health care professional. 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.end deletebegin insert a child psychiatrist or behavioral pediatrician, as specified.end 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 child’s social worker to submit a report to the court prior tobegin delete theend deletebegin insert anyend insert review hearing, to include information from the child, the child’s caregiver, the public health nurse, and thebegin delete court appointedend deletebegin insert court-appointedend insert special advocate. By increasing the duties of county social workers,begin delete thisend deletebegin insert theend insert bill wouldbegin delete createend deletebegin insert imposeend insert 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 asbegin delete practical,end deletebegin insert practical thereafter,end insert 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 rulesbegin insert of court and develop appropriate formsend insert to implement thesebegin delete provisions.end deletebegin insert provisions by January 1, 2018.end insert

This bill wouldbegin insert alsoend insert require the State Department of Health Care Services, in collaboration with the Judicial Council, to identify resources to assist courts in securingbegin delete 2nd opinionsend deletebegin insert preauthorization reviewsend insert in those counties in which there are fewer than 10 practicing child and adolescent psychiatrists in order to avoid undue delays in the authorization of psychotropic medications.

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, 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.

end delete
begin insert

This bill would incorporate changes to Section 4064.5 of the Business and Professions Code proposed by both this bill and SB 999, which would become operative only if both bills are enacted and become effective on or before January 1, 2017, and this bill is chaptered last.

end insert
begin insert

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 insert
begin insert

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

end insert

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.

P4    1(2) The total quantity of dosage units dispensed does not exceed
2the total quantity of dosage units authorized by the prescriber on
3the prescription, including refills.

4(3) The prescriber has not specified on the prescription that
5dispensing the prescription in an initial amount followed by
6periodic refills is medically necessary.

7(4) The pharmacist is exercising his or her professional
8judgment.

9(b) For purposes of this section, if the prescription continues
10the same medication as previously dispensed in a 90-day supply,
11the initial 30-day supply under paragraph (1) of subdivision (a) is
12not required.

13(c) A pharmacist dispensing an increased supply of a dangerous
14drug pursuant to this section shall notify the prescriber of the
15increase in the quantity of dosage units dispensed.

16(d) In no case shall a pharmacist dispense a greater supply of a
17dangerous drug pursuant to this section if the prescriber personally
18indicates, either orally or in his or her own handwriting, “No
19change to quantity,” or words of similar meaning. Nothing in this
20subdivision shall prohibit a prescriber from checking a box on a
21prescription marked “No change to quantity,” provided that the
22prescriber personally initials the box or checkmark. To indicate
23that an increased supply shall not be dispensed pursuant to this
24section for an electronic data transmission prescription as defined
25in subdivision (c) of Section 4040, a prescriber may indicate “No
26change to quantity,” or words of similar meaning, in the
27prescription as transmitted by electronic data, or may check a box
28marked on the prescription “No change to quantity.” In either
29instance, it shall not be required that the prohibition on an increased
30supply be manually initialed by the prescriber.

31(e) This section does not apply to psychotropic medication or
32psychotropic drugs as described in Sections 369.5 and 739.5 of
33the Welfare and Institutions Code.

34(f) Nothing in this section shall be construed to require a health
35care service plan, health insurer, workers’ compensation insurance
36plan, pharmacy benefits manager, or any other person or entity,
37including, but not limited to, a state program or state employer, to
38provide coverage for a dangerous drug in a manner inconsistent
39with a beneficiary’s plan benefit.

P5    1begin insert

begin insertSEC. 1.5.end insert  

end insert

begin insertSection 4064.5 of the end insertbegin insertBusiness and Professions Codeend insert
2
begin insert is amended to read:end insert

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.

22(c) A pharmacist dispensing an increased supply of a dangerous
23drug pursuant to this section shall notify the prescriber of the
24increase in the quantity of dosage units dispensed.

25(d) In no case shall a pharmacist dispense a greater supply of a
26dangerous drug pursuant to this section if the prescriber personally
27indicates, either orally or in his or her own handwriting, “No
28change to quantity,” or words of similar meaning. Nothing in this
29subdivision shall prohibit a prescriber from checking a box on a
30prescription marked “No change to quantity,” provided that the
31prescriber personally initials the box or checkmark. To indicate
32that an increased supply shall not be dispensed pursuant to this
33section for an electronic data transmission prescription as defined
34in subdivision (c) of Section 4040, a prescriber may indicate “No
35change to quantity,” or words of similar meaning, in the
36prescription as transmitted by electronic data, or may check a box
37marked on the prescription “No change to quantity.” In either
38instance, it shall not be required that the prohibition on an increased
39supply be manually initialed by the prescriber.

P6    1(e) This sectionbegin delete shallend deletebegin insert doesend insert not apply to psychotropic medication
2or psychotropic drugs as described inbegin delete subdivision (d) of Section
3369.5end delete
begin insert Sections 369.5 and 739.5end insert of the Welfare and Institutions
4Code.

begin insert

5
(f) Except for the provisions of subdivision (d), this section does
6not apply to FDA-approved, self-administered hormonal
7contraceptives.

end insert
begin insert

8
(1) A pharmacist shall dispense, at a patient’s request, up to a
912-month supply of an FDA-approved, self-administered hormonal
10contraceptive pursuant to a valid prescription that specifies an
11initial quantity followed by periodic refills.

end insert
begin insert

12
(2) A pharmacist furnishing an FDA-approved self-administered
13hormonal contraceptive pursuant to Section 4052.3 under protocols
14developed by the Board of Pharmacy may furnish, at the patient’s
15request, up to a 12-month supply at one time.

end insert
begin insert

16
(3) Nothing in this subdivision shall be construed to require a
17pharmacist to dispense or furnish a drug if it would result in a
18violation of Section 733.

end insert
begin delete

19(f)

end delete

20begin insert(g)end insert Nothing in this section shall be construed to require a health
21care service plan, health insurer, workers’ compensation insurance
22plan, pharmacy benefits manager, or any other person or entity,
23including, but not limited to, a state program or state employer, to
24provide coverage for a dangerous drug in a manner inconsistent
25with a beneficiary’s plan benefit.

26

SEC. 2.  

Section 369.4 is added to the Welfare and Institutions
27Code
, to read:

28

369.4.  

The State Department of Health Care Services, in
29collaboration with the Judicial Council, shall identify resources,
30which may include, but need not be limited to, university-based
31consultation services, to assist the courts in securingbegin delete second
32opinionsend delete
begin insert preauthorization reviewsend insert in those counties in which there
33are fewer than 10 practicing child and adolescent psychiatrists in
34order to avoid undue delays in the authorization of medications
35pursuant to Sections 369.5 andbegin delete 739.5 of the Welfare and Institutions
36Code.end delete
begin insert 739.5.end insert

begin delete
37

SEC. 3.  

Section 369.5 of the Welfare and Institutions Code is
38amended to read:

39

369.5.  

(a) If a child is adjudged a dependent child of the court
40under Section 300 and the child has been removed from the
P7    1physical custody of the parent under Section 361, only a juvenile
2court judicial officer shall have authority to make orders regarding
3the administration of psychotropic medications for that child. The
4juvenile court may issue a specific order delegating this authority
5to a parent upon making findings on the record that the parent
6poses no danger to the child and has the capacity to authorize
7psychotropic medications. Court authorization for the
8administration of psychotropic medication shall be based on a
9request from a physician, indicating the reasons for the request, a
10description of the child’s diagnosis and behavior, the expected
11results of the medication, and a description of any side effects of
12the medication. On or before July 1, 2000, the Judicial Council
13shall adopt rules of court and develop appropriate forms for
14implementation of this section.

15(b) (1) In counties in which the county child welfare agency
16completes the request for authorization for the administration of
17psychotropic medication, the agency is encouraged to complete
18the request within three business days of receipt from the physician
19of the information necessary to fully complete the request.

20(2) Nothing in this subdivision is intended to change current
21local practice or local court rules with respect to the preparation
22and submission of requests for authorization for the administration
23of psychotropic medication.

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

30(d) Psychotropic medication or psychotropic drugs are those
31medications administered for the purpose of affecting the central
32nervous system to treat psychiatric disorders or illnesses. These
33medications include, but are not limited to, anxiolytic agents,
34antidepressants, mood stabilizers, antipsychotic medications,
35anti-Parkinson agents, hypnotics, medications for dementia, and
36psychostimulants.

37(e) Nothing in this section is intended to supersede local court
38rules regarding a minor’s right to participate in mental health
39decisions.

P8    1(f) This section shall not apply to nonminor dependents, as
2defined in subdivision (v) of Section 11400.

3(g) This section shall become inoperative on July 1, 2016, and
4as of January 1, 2017, is repealed, unless a later enacted statute,
5that is enacted before January 1, 2017, deletes or extends that date.

6

SEC. 4.  

Section 369.5 is added to the Welfare and Institutions
7Code
, to read:

8

369.5.  

(a) If a child is adjudged a dependent child of the court
9under Section 300 and the child has been removed from the
10physical custody of the parent under Section 361, only a juvenile
11court judicial officer shall have authority to make orders regarding
12the administration of psychotropic medications for that child. The
13juvenile court may issue a specific order delegating this authority
14to a parent, upon making findings on the record that the parent
15poses no danger to the child and has the capacity to authorize
16psychotropic medications. Court authorization for the
17administration of psychotropic medication shall be based on a
18request from a physician, indicating the reasons for the request, a
19description of the child’s diagnosis and behavior, the expected
20results of the medication, and a description of any side effects of
21the medication. On or before July 1, 2016, the Judicial Council
22shall adopt rules of court and develop appropriate forms for
23implementation of this section. If the court authorizes the
24administration of a psychotropic medication, it shall verify that
25the administration of the psychotropic medication is only one part
26of a comprehensive treatment plan for the child that shall include
27and specify the psychosocial, behavioral, and alternative services,
28if any, the child will receive in addition to any authorized
29medication.

30(b) (1) An order authorizing the administration of psychotropic
31medications pursuant to this section shall be granted only upon
32the court’s determination that the administration of the medication
33is in the best interest of the child based on a determination that the
34anticipated benefits of the psychotropic medication outweigh the
35short- and long-term risks associated with the medications. An
36order authorizing the administration of psychotropic medication
37pursuant to this section shall not be granted if the court determines
38that the medication is being used as punishment, for purposes other
39than the treatment of a diagnosed mental health condition, as a
P9    1substitute for other less invasive treatments, or in quantities or
2dosages that interfere with the child’s treatment program.

3(2) An order authorizing the administration of psychotropic
4medications pursuant to this section shall be granted only if the
5court determines all of the following:

6(A) The court is provided documentation confirming the child’s
7caregiver has been informed, and the child has been informed in
8an age and developmentally appropriate manner in the primary
9language of the child, about the recommended medications, the
10anticipated benefits, the nature, degree, duration, and probability
11of side effects and significant risks commonly known by the
12medical profession, and of psychosocial treatments and
13interventions specific to the identified disorder and symptoms to
14be considered concurrently with or as an alternative to the
15medication.

16(i) The documentation shall state that the child and the child’s
17caregiver have been asked whether either have concerns regarding
18the medication, and if so, shall describe the nature of those
19concerns.

20(ii) The documentation shall confirm that the child has been
21informed of the right to object to the authorization of psychotropic
22medication and to request a hearing pursuant to subdivision (g).

23(iii) The documentation shall include the written assent or refusal
24to assent of a child who is 12 years of age or older.

25(B) The prescribing physician submitting the request for
26psychotropic medication has conducted a comprehensive
27examination of the child that complies with Section 2242 of the
28Business and Professions Code and that takes into account all of
29the following:

30(i) The child’s trauma history.

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

32(iii) Information from multiple sources that should include, but
33are not limited to, the child, the child’s parents, relatives, teacher,
34caregiver or caregivers, past prescribers of psychotropic
35medication, or other health care providers.

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

37(i) There are no less invasive treatment options available to meet
38the needs of the child.

39(ii) The dosage or dosage range requested is appropriate for the
40child.

P10   1(iii) The short- and long-term risks associated with the use of
2psychotropic medications by the child does not outweigh the
3reported benefits to the child.

4(iv) All appropriate laboratory screenings, measurements, or
5tests for the child have been completed in accordance with accepted
6medical guidelines.

7(D) A plan is in place for regular monitoring of the child’s
8medication and psychosocial treatment plan, the effectiveness of
9the medication and psychosocial treatment, and any potential side
10effects of the medication, by the physician in consultation with
11the caregiver, mental health care provider, and others who have
12contact with the child, as appropriate.

13(3) The person or entity submitting the request for authorization
14of the administration of psychotropic medication is responsible
15for providing the necessary documentation of the clinical
16appropriateness of the proposed psychotropic medication and shall
17bear the burden of proof.

18(c) A court shall not issue an order authorizing the administration
19of psychotropic medications for a child described in subdivision
20(a) unless a second medical opinion is obtained from an
21appropriately qualified health care professional, as defined in
22subdivision (b) of Section 1383.15 of the Health and Safety Code,
23if one or more of the following circumstances exist:

24(1) The request is for any class of psychotropic medication for
25a child who is five years of age or younger.

26(2) The request would result in the child being administered
27three or more psychotropic medications concurrently.

28(3) The request is for the concurrent administration of two
29antipsychotic medications unless the request is for medication
30tapering and replacement that is limited to no more than 45 days.

31(d) The court shall not authorize the administration of the
32psychotropic medication for a child described in subdivision (a)
33unless the court is provided with documentation that appropriate
34laboratory screenings, measurements, or tests for the child have
35been completed no more than 45 days prior to submission of the
36request to the court in accordance with accepted medical guidelines.

37(e) (1) No later than 60 days after the authorization of a new
38psychotropic medication is granted or at the next review hearing
39scheduled for a child described in subdivision (a), if scheduled no
40earlier than 45 days after the authorization of a new psychotropic
P11   1medication, the court shall conduct a review hearing to determine
2all of the following:

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

4(B) Whether psychosocial services and other aspects of the
5child’s treatment plan have been provided to the child.

6(C) To what extent the symptoms for which the medication or
7medications were authorized have been alleviated.

8(D) Whether more time is needed to evaluate the effectiveness
9of the medication or medications.

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

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

12(G) The date or dates of followup visits with the prescribing
13physician since the medication or medications were authorized.

14(H) Whether the appropriate followup laboratory screenings
15have been performed and their findings.

16(2) Prior to the review, the child’s social worker shall submit a
17report to the court and to counsel for the parties, which shall
18include information from the child, the child’s caregiver, the public
19health nurse, and the court appointed special advocate, if any.

20(3) If based upon this review, the court determines that the
21proffered benefits of the medication have not been demonstrated
22or that the risks of the medication outweigh the benefits, the court
23shall reconsider, modify, or revoke its authorization for the
24administration of medication.

25(f) (1) In counties in which the county child welfare agency
26completes the request for authorization for the administration of
27psychotropic medication, the agency is encouraged to complete
28the request within three business days of receipt from the physician
29of the information necessary to fully complete the request.

30(2) This subdivision is not intended to change current local
31practice or local court rules with respect to the preparation and
32submission of requests for authorization for the administration of
33 psychotropic medication.

34(g) Within seven court days from receipt by the court of a
35completed request, the juvenile court judicial officer shall either
36approve or deny in writing a request for authorization for the
37administration of psychotropic medication to the child, refer the
38request for a second opinion as required by subdivision (c), or
39shall, upon a request by the parent, the legal guardian, or the child’s
40attorney, or upon its own motion, set the matter for hearing.

P12   1(h) If the court grants the request, or modifies and grants the
2request, the order for authorization is effective until terminated or
3modified by court order or until 180 days following the date of the
4order, whichever date occurs earlier.

5(i) Psychotropic medication or psychotropic drugs are those
6medications administered for the purpose of affecting the central
7nervous system to treat psychiatric disorders or illnesses. These
8medications include, but are not limited to, anxiolytic agents,
9antidepressants, mood stabilizers, antipsychotic medications,
10anti-Parkinson agents, hypnotics, medications for dementia, and
11psychostimulants.

12(j) (1) Psychotropic medications may be administered without
13court authorization to a child described in subdivision (a) in an
14emergency. An emergency exists if all of the following conditions
15are met:

16(A) A physician finds that the child requires psychotropic
17medication to treat a psychiatric disorder or illness.

18(B) The medication is immediately necessary for the
19preservation of life or the prevention of serious bodily harm to the
20child or others. It is not necessary for the harm to take place or
21become unavoidable prior to treatment.

22(C) It is impractical to obtain authorization from the court before
23administering the psychotropic medication to the child.

24(2) Court authorization shall be sought as soon as practical, but
25in no case more than two court days after the emergency
26administration of psychotropic medication.

27(k) This section is not intended to supersede local court rules
28regarding a minor’s right to participate in mental health decisions.

29(l) This section does not grant any person the authority to
30administer psychotropic medication to a child who indicates a
31refusal of treatment with the authorized medication. A person shall
32not threaten, coerce, withhold privileges, or otherwise penalize a
33child for refusing to take a psychotropic medication. A child
34 described in subdivision (a) shall not be involuntarily administered
35a psychotropic medication unless otherwise specifically permitted
36by statute.

37(m) This section shall not apply to nonminor dependents, as
38defined in subdivision (v) of Section 11400.

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

P13   1

SEC. 5.  

Section 739.5 of the Welfare and Institutions Code is
2amended to read:

3

739.5.  

(a) If a minor who has been adjudged a ward of the
4court under Section 601 or 602 is removed from the physical
5custody of the parent under Section 726 and placed into foster
6care, as defined in Section 727.4, only a juvenile court judicial
7officer shall have authority to make orders regarding the
8administration of psychotropic medications for that minor. The
9juvenile court may issue a specific order delegating this authority
10to a parent upon making findings on the record that the parent
11poses no danger to the minor and has the capacity to authorize
12psychotropic medications. Court authorization for the
13administration of psychotropic medication shall be based on a
14request from a physician, indicating the reasons for the request, a
15description of the minor’s diagnosis and behavior, the expected
16results of the medication, and a description of any side effects of
17the medication. On or before July 1, 2008, the Judicial Council
18shall adopt rules of court and develop appropriate forms for
19implementation of this section.

20(b) (1) The agency that completes the request for authorization
21for the administration of psychotropic medication is encouraged
22to complete the request within three business days of receipt from
23the physician of the information necessary to fully complete the
24request.

25(2) Nothing in this subdivision is intended to change current
26local practice or local court rules with respect to the preparation
27and submission of requests for authorization for the administration
28of psychotropic medication.

29(c) Within seven court days from receipt by the court of a
30completed request, the juvenile court judicial officer shall either
31 approve or deny in writing a request for authorization for the
32administration of psychotropic medication to the minor, or shall,
33upon a request by the parent, the legal guardian, or the minor’s
34attorney, or upon its own motion, set the matter for hearing.

35(d) Psychotropic medication or psychotropic drugs are those
36medications administered for the purpose of affecting the central
37nervous system to treat psychiatric disorders or illnesses. These
38medications include, but are not limited to, anxiolytic agents,
39antidepressants, mood stabilizers, antipsychotic medications,
P14   1anti-Parkinson agents, hypnotics, medications for dementia, and
2psychostimulants.

3(e) Nothing in this section is intended to supersede local court
4rules regarding a minor’s right to participate in mental health
5decisions.

6(f) This section shall become inoperative on July 1, 2016, and
7as of January 1, 2017, is repealed, unless a later enacted statute,
8that is enacted before January 1, 2017, deletes or extends that date.

9

SEC. 6.  

Section 739.5 is added to the Welfare and Institutions
10Code
, to read:

11

739.5.  

(a) If a minor who has been adjudged a ward of the
12court under Section 601 or 602 is removed from the physical
13custody of the parent under Section 726 and placed into foster
14care, as defined in Section 727.4, only a juvenile court judicial
15officer shall have authority to make orders regarding the
16administration of psychotropic medications for that minor. 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 minor 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 minor’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. If the court authorizes the
28administration of a psychotropic medication, it shall verify that
29the administration of the psychotropic medication is only one part
30of a comprehensive treatment plan for the minor that shall include
31and specify the psychosocial, behavioral, and alternative services,
32if any, the minor will receive in addition to any authorized
33medication.

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 the administration of the medication
37is in the best interest of the minor based on a determination that
38the anticipated benefits of the psychotropic medication outweigh
39the short- and long-term risks associated with the medications. An
40order authorizing the administration of psychotropic medication
P15   1pursuant to this section shall not be granted if the court determines
2that the medication is being used as punishment, for purposes other
3than the treatment of a diagnosed mental health condition, as a
4substitute for other less invasive treatments, or in quantities or
5dosages that interfere with the minor’s treatment program.

6(2) An order authorizing the administration of psychotropic
7medications pursuant to this section shall be granted only if the
8court determines all of the following:

9(A) The court is provided documentation confirming the minor’s
10caregiver has been informed, and the minor has been informed in
11an age and developmentally appropriate manner in the primary
12language of the minor, about the recommended medications, the
13anticipated benefits, the nature, degree, duration, and probability
14of side effects and significant risks commonly known by the
15medical profession, and of psychosocial treatments and
16interventions specific to the identified disorder and symptoms to
17be considered concurrently with, or as an alternative to, the
18medication.

19(i) The documentation shall state that the minor and the minor’s
20caregiver have been asked whether either have concerns regarding
21the medication, and if so, shall describe the nature of those
22concerns.

23(ii) The documentation shall confirm that the minor has been
24informed of the right to object to the authorization of psychotropic
25medication and to request a hearing pursuant to subdivision (g).

26(iii) The documentation shall include the written assent or refusal
27to assent of a minor who is 12 years of age or older.

28(B) The prescribing physician submitting the request for
29psychotropic medication has conducted a comprehensive
30examination of the minor that complies with Section 2242 of the
31Business and Professions Code and that takes into account all of
32the following:

33(i) The minor’s trauma history.

34(ii) The minor’s health care history, including medication
35history.

36(iii) Information from multiple sources that should include, but
37are not limited to, the minor, the minor’s parents, relatives, teacher,
38caregiver or caregivers, past prescribers of psychotropic
39medication, or other health care providers.

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

P16   1(i) There are no less invasive treatment options available to meet
2the needs of the minor.

3(ii) The dosage or dosage range requested is appropriate for the
4minor.

5(iii) The short- and long-term risks associated with the use of
6psychotropic medications by the minor does not outweigh the
7reported benefits to the minor.

8(iv) All appropriate laboratory screenings, measurements, or
9tests for the minor have been completed in accordance with
10accepted medical guidelines.

11(D) A plan is in place for regular monitoring of the minor’s
12medication and psychosocial treatment plan, the effectiveness of
13the medication and psychosocial treatment, and any potential side
14effects of the medication by the physician in consultation with the
15caregiver, mental health care provider, and others who have contact
16with the minor, as appropriate.

17(3) The person or entity submitting the request for authorization
18of the administration of psychotropic medication is responsible
19for providing the necessary documentation of the clinical
20appropriateness of the proposed psychotropic medication and shall
21bear the burden of proof.

22(c) A court shall not issue an order authorizing the administration
23of psychotropic medications for a minor described in subdivision
24(a) unless a second medical opinion is obtained from an
25appropriately qualified health care professional, as defined in
26subdivision (b) of Section 1383.15 of the Health and Safety Code,
27if one or more of the following circumstances exist:

28(1) The request is for any class of psychotropic medication for
29a minor who is five years of age or younger.

30(2) The request would result in the minor being administered
31three or more psychotropic medications concurrently.

32(3) The request is for the concurrent administration of two
33antipsychotic medications unless the request is for medication
34tapering and replacement that is limited to no more than 45 days.

35(d) The court shall not authorize the administration of the
36psychotropic medication for a minor described in subdivision (a)
37unless the court is provided with documentation that appropriate
38laboratory screenings, measurements, or tests for the minor have
39been completed no more than 45 days prior to submission of the
40request to the court in accordance with accepted medical guidelines.

P17   1(e) (1) No later than 60 days after the authorization of a new
2psychotropic medication is granted or at the next review hearing
3scheduled for a minor described in subdivision (a), if scheduled
4no earlier than 45 days after the authorization of a new psychotropic
5medication, the court shall conduct a review hearing to determine
6all of the following:

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

8(B) Whether psychosocial services and other aspects of the
9minor’s treatment plan have been provided to the minor.

10(C) To what extent the symptoms for which the medication or
11medications were authorized have been alleviated.

12(D) Whether more time is needed to evaluate the effectiveness
13of the medication or medications.

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

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

16(G) The date or dates of followup visits with the prescribing
17physician since the medication or medications were authorized.

18(H) Whether the appropriate followup laboratory screenings
19have been performed and their findings.

20(2) Prior to the review, the minor’s probation officer shall submit
21a report to the court and to counsel for the parties, which shall
22include information from the minor, the minor’s caregiver, the
23public health nurse, and the court appointed special advocate, if
24any.

25(3) If based upon this review, the court determines that the
26proffered benefits of the medication have not been demonstrated
27or that the risks of the medication outweigh the benefits, the court
28shall reconsider, modify, or revoke its authorization for the
29administration of medication.

30(f) (1) The agency that completes the request for authorization
31for the administration of psychotropic medication is encouraged
32to complete the request within three business days of receipt from
33the physician of the information necessary to fully complete the
34request.

35(2) Nothing in this section is intended to change current local
36practice or local court rules with respect to the preparation and
37submission of requests for authorization for the administration of
38psychotropic medication.

39(g) Within seven court days from receipt by the court of a
40completed request, the juvenile court judicial officer shall either
P18   1approve or deny in writing a request for authorization for the
2administration of psychotropic medication to the minor, refer the
3request for a second opinion as required by subdivision (c), or
4shall, upon a request by the parent, the legal guardian, or the
5minor’s attorney, or upon its own motion, set the matter for hearing.

6(h) If the court grants the request, or modifies and grants the
7request, the order for authorization is effective until terminated or
8modified by court order or until 180 days following the date of the
9order, whichever is earlier.

10(i) Psychotropic medication or psychotropic drugs are those
11medications administered for the purpose of affecting the central
12nervous system to treat psychiatric disorders or illnesses. These
13medications include, but are not limited to, anxiolytic agents,
14 antidepressants, mood stabilizers, antipsychotic medications,
15anti-Parkinson agents, hypnotics, medications for dementia, and
16psychostimulants.

17(j) (1) Psychotropic medications may be administered without
18court authorization to a minor described in subdivision (a) in an
19emergency. An emergency exists if all of the following conditions
20are met:

21(A) A physician finds that the minor requires psychotropic
22medication to treat a psychiatric disorder or illness.

23(B) The medication is immediately necessary for the
24preservation of life or the prevention of serious bodily harm to the
25minor or others. It is not necessary for the harm to take place or
26become unavoidable prior to treatment.

27(C) It is impractical to obtain authorization from the court before
28administering the psychotropic medication to the minor.

29(2) Court authorization shall be sought as soon as practical, but
30in no case more than two court days after the emergency
31administration of psychotropic medication.

32(k) This section is not intended to supersede local court rules
33regarding a minor’s right to participate in mental health decisions.

34(l) This section does not grant any person the authority to
35administer psychotropic medication to a minor who indicates a
36refusal of treatment with the authorized medication. A person shall
37not threaten, coerce, withhold privileges, or otherwise penalize a
38minor for refusing to take a psychotropic medication. A minor
39described in subdivision (a) shall not be involuntarily administered
P19   1a psychotropic medication unless otherwise specifically permitted
2by statute.

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

4

SEC. 7.  

If the Commission on State Mandates determines that
5this act contains costs mandated by the state, reimbursement to
6local agencies and school districts for those costs shall be made
7pursuant to Part 7 (commencing with Section 17500) of Division
84 of Title 2 of the Government Code.

end delete
9begin insert

begin insertSEC. 3.end insert  

end insert

begin insertSection 369.5 of the end insertbegin insertWelfare and Institutions Codeend insertbegin insert is
10amended to read:end insert

11

369.5.  

(a) (1) If a child is adjudged a dependent child of the
12court under Section 300 andbegin delete the childend delete has been removed from the
13physical custody of the parent under Section 361, only a juvenile
14court judicial officer shall have authority to make orders regarding
15the administration of psychotropic medications for that child. The
16juvenile court may issue a specific order delegating this authority
17to a parent upon making findings on the record that the parent
18poses no danger to the child and has the capacity to authorize
19psychotropic medications. Court authorization for the
20administration of psychotropic medication shall be based on a
21request from a physician, indicating the reasons for the request, a
22description of the child’s diagnosis and behavior, the expected
23results of the medication, and a description of any side effects of
24the medication.

25(2) (A) On or before July 1, 2016, the Judicial Council shall
26amend and adopt rules of court and develop appropriate forms for
27the implementation of this section, in consultation with the State
28Department of Social Services, the State Department of Health
29Care Services, and stakeholders, including, but not limited to, the
30County Welfare Directors Association of California, the County
31Behavioral Health Directors Association of California, the Chief
32Probation Officers of California, associations representing current
33and former foster children, caregivers, and children’s attorneys.
34This effort shall be undertaken in coordination with the updates
35required under paragraph (2) of subdivision (a) of Section 739.5.

36(B) The rules of court and forms developed pursuant to
37subparagraph (A) shall address all of the following:

38(i) The child and his or her caregiver and court-appointed special
39advocate, if any, have an opportunity to provide input on the
40medications being prescribed.

P20   1(ii) Information regarding the child’s overall mental health
2assessment and treatment plan is provided to the court.

3(iii) Information regarding the rationale for the proposed
4medication, provided in the context of past and current treatment
5efforts, is provided to the court. This information shall include,
6but not be limited to, information on other pharmacological and
7nonpharmacological treatments that have been utilized and the
8child’s response to those treatments, a discussion of symptoms not
9alleviated or ameliorated by other current or past treatment efforts,
10and an explanation of how the psychotropic medication being
11prescribed is expected to improve the child’s symptoms.

12(iv) Guidance is provided to the court on how to evaluate the
13request for authorization, including how to proceed if information,
14otherwise required to be included in a request for authorization
15under this section, is not included in a request for authorization
16submitted to the court.

17(C) The rules of court and forms developed pursuant to
18subparagraph (A) shall include a process for periodic oversight by
19the court of orders regarding the administration of psychotropic
20medications that includes the caregiver’s and child’s observations
21regarding the effectiveness of the medication and side effects,
22information on medication management appointments and other
23followup appointments with medical practitioners, and information
24on the delivery of other mental health treatments that are a part of
25 the child’s overall treatment plan. The periodic oversight shall be
26facilitated by the county social worker, public health nurse, or
27other appropriate county staff. This oversight process shall be
28conducted in conjunction with other regularly scheduled court
29hearings and reports provided to the court by the county child
30welfare agency.

31(b) (1) In counties in which the county child welfare agency
32completes the request for authorization for the administration of
33psychotropic medication, the agency is encouraged to complete
34the request within three business days of receipt from the physician
35of the information necessary to fully complete the request.

36(2) Nothing in this subdivision is intended to change current
37local practice or local court rules with respect to the preparation
38and submission of requests for authorization for the administration
39of psychotropic medication.

P21   1(c) (1) Within seven court days from receipt by the court of a
2completed request, the juvenile court judicial officer shall either
3approve or deny in writing a request for authorization for the
4administration of psychotropic medication to the child, or shall,
5upon a request by the parent, the legal guardian, or the child’s
6attorney, or upon its own motion, set the matter for hearing.

7(2) Notwithstanding Section 827 or any other law, upon the
8approval or denial by the juvenile court judicial officer of a request
9for authorization for the administration of psychotropic medication,
10the county child welfare agency or other person or entity who
11submitted the request shall provide a copy of the court order
12approving or denying the request to the child’s caregiver.

13(d) Psychotropic medication or psychotropic drugs are those
14medications administered for the purpose of affecting the central
15nervous system to treat psychiatric disorders or illnesses. These
16medications include, but are not limited to, anxiolytic agents,
17antidepressants, mood stabilizers, antipsychotic medications,
18anti-Parkinson agents, hypnotics, medications for dementia, and
19psychostimulants.

20(e) Nothing in this section is intended to supersede local court
21rules regarding a minor’s right to participate in mental health
22decisions.

23(f) This section does not apply to nonminor dependents, as
24defined in subdivision (v) of Section 11400.

begin insert

25
(g) This section shall remain in effect only until January 1, 2018,
26and as of that date is repealed, unless a later enacted statute, that
27is enacted before January 1, 2018, deletes or extends that date.

end insert
28begin insert

begin insertSEC. 4.end insert  

end insert

begin insertSection 369.5 is added to the end insertbegin insertWelfare and Institutions
29Code
end insert
begin insert, to read:end insert

begin insert
30

begin insert369.5.end insert  

(a) If a child is adjudged a dependent child of the court
31under Section 300 and has been removed from the physical custody
32of the parent under Section 361, only a juvenile court judicial
33officer shall have authority to make orders regarding the
34administration of psychotropic medications for that child. The
35juvenile court may issue a specific order delegating this authority
36to a parent, upon making findings on the record that the parent
37poses no danger to the child and has the capacity to authorize
38psychotropic medications. Court authorization for the
39administration of psychotropic medication shall be based on a
40request from a physician, indicating the reasons for the request,
P22   1a description of the child’s diagnosis and behavior, the expected
2results of the medication, and a description of any side effects of
3the medication. If the court authorizes the administration of a
4psychotropic medication, it shall verify that the administration of
5the psychotropic medication is only one part of a comprehensive
6treatment plan for the child that shall include and specify the
7psychosocial, behavioral, and alternative services, if any, the child
8will receive in addition to any authorized medication.

9
(b) (1) An order authorizing the administration of psychotropic
10medications pursuant to this section shall be granted only upon
11the court’s determination that the administration of the medication
12is in the best interest of the child based on a determination that
13the anticipated benefits of the psychotropic medication outweigh
14the short- and long-term risks associated with the medications. An
15order authorizing the administration of psychotropic medication
16pursuant to this section shall not be granted if the court determines
17that the medication is being used as punishment, for purposes
18other than the treatment of a diagnosed mental health condition,
19as a substitute for other less invasive treatments, or in quantities
20or dosages that interfere with the child’s treatment program.

21
(2) An order authorizing the administration of psychotropic
22medications pursuant to this section shall be granted only if the
23court determines all of the following:

24
(A) The court is provided documentation confirming the child’s
25caregiver has been informed, and the child has been informed in
26an age and developmentally appropriate manner in the primary
27language of the child, about the recommended medications, the
28anticipated benefits, the nature, degree, duration, and probability
29of side effects and significant risks commonly known by the medical
30profession, and of psychosocial treatments and interventions
31specific to the identified disorder and symptoms to be considered
32concurrently with or as an alternative to the medication.

33
(i) The documentation shall state that the child and the child’s
34caregiver have been asked whether either have concerns regarding
35the medication, and, if so, shall describe the nature of those
36concerns.

37
(ii) The documentation shall confirm that the child has been
38informed of the right to object to the authorization of psychotropic
39medication and to request a hearing pursuant to paragraph (1) of
40subdivision (g).

P23   1
(iii) The documentation shall include the written consent or
2refusal to consent of a child who is 12 years of age or older.

3
(B) The prescribing physician submitting the request for
4psychotropic medication was provided a copy of the child’s health
5and education summary or passport as described in Section 16010.

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

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

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

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

14
(iv) All appropriate measurements have been completed and
15all appropriate laboratory screenings or tests have been performed
16or ordered for the child in accordance with accepted medical
17guidelines.

18
(D) A plan is in place for regular monitoring of the child’s
19medication and psychosocial treatment plan, the effectiveness of
20the medication and psychosocial treatment, and any potential side
21effects of the medication, by the physician in consultation with the
22caregiver, mental health care provider, and others who have
23contact with the child, as appropriate.

24
(3) The person or entity submitting the request for authorization
25of the administration of psychotropic medication is responsible
26for providing the necessary documentation of the clinical
27appropriateness of the proposed psychotropic medication and
28shall bear the burden of proof.

29
(c) (1) A court shall not issue an order authorizing the
30administration of psychotropic medications for a child described
31in subdivision (a) unless a preauthorization review is obtained
32from a child psychiatrist or behavioral pediatrician, if one or more
33of the following circumstances exist:

34
(A) The request is for any class of psychotropic medication for
35a child who is five years of age or younger.

36
(B) The request would result in the child being administered
37three or more psychotropic medications concurrently.

38
(C) The request is for the concurrent administration of two
39antipsychotic medications unless the request is for medication
40tapering and replacement that is limited to no more than 45 days.

P24   1
(2) Preauthorization review under this subdivision does not
2require a face-to-face assessment of the child for whom the
3psychotropic medications are prescribed. The court, on its own
4motion or upon the request of the child’s attorney or the parent
5or parent’s attorney, may order that assessment to be completed
6before deciding whether or not to approve the request to authorize
7the medication. The health care professional providing the
8preauthorization review shall review all the information submitted
9to the court, including, but not limited to, the prescribing
10physician’s statement and the child’s health and education
11summary or passport, and, if deemed necessary, conduct a
12telephone consultation with the prescriber or the public health
13nurse responsible for the child pursuant to Section 16501.3.

14
(d) The court shall not authorize the administration of the
15psychotropic medication for a child described in subdivision (a)
16unless the court is provided with documentation that appropriate
17laboratory screenings, measurements, or tests for the child have
18been completed no more than 45 days prior to submission of the
19request to the court in accordance with accepted medical
20guidelines.

21
(e) (1) No later than 60 days after the authorization of a new
22psychotropic medication is granted or at the next review hearing
23scheduled for a child described in subdivision (a), if scheduled no
24earlier than 45 days after the authorization of a new psychotropic
25medication, the court shall conduct a review hearing to determine
26all of the following:

27
(A) Whether the child is taking the medication or medications.

28
(B) Whether psychosocial services and other aspects of the
29child’s treatment plan have been provided to the child.

30
(C) To what extent the symptoms for which the medication or
31medications were authorized have been alleviated.

32
(D) Whether more time is needed to evaluate the effectiveness
33of the medication or medications.

34
(E) What, if any, adverse effects the child has suffered.

35
(F) Any steps taken to address those effects.

36
(G) The date or dates of followup visits with the prescribing
37physician since the medication or medications were authorized.

38
(H) Whether the appropriate followup laboratory screenings
39have been performed and their findings.

P25   1
(2) Prior to the review, the child’s social worker shall submit
2a report to the court and to counsel for the parties, which shall
3include information from the child, the child’s caregiver, the public
4health nurse, and the court-appointed special advocate, if any.

5
(3) If, based upon this review, the court determines that the
6proffered benefits of the medication have not been demonstrated
7or that the risks of the medication outweigh the benefits, the court
8shall reconsider, modify, or revoke its authorization for the
9administration of medication.

10
(f) (1) In counties in which the county child welfare agency
11completes the request for authorization for the administration of
12psychotropic medication, the agency is encouraged to complete
13the request within three business days of receipt from the physician
14of the information necessary to fully complete the request.

15
(2) Nothing in this subdivision is intended to change current
16local practice or local court rules with respect to the preparation
17and submission of requests for authorization for the administration
18of psychotropic medication.

19
(g) (1) Within seven court days from receipt by the court of a
20completed request, the juvenile court judicial officer shall either
21approve or deny in writing a request for authorization for the
22administration of psychotropic medication to the child, refer the
23request for a preauthorization review as required by subdivision
24(c), or shall, upon a request by the parent, the legal guardian, or
25the child’s attorney, or upon its own motion, set the matter for
26hearing.

27
(2) Notwithstanding Section 827 or any other law, upon the
28approval or denial by the juvenile court judicial officer of a request
29for authorization for the administration of psychotropic medication,
30the county child welfare agency or other person or entity who
31submitted the request shall provide a copy of the court order
32approving or denying the request to the child’s caregiver.

33
(h) If the court grants the request, or modifies and grants the
34request, the order for authorization is effective until terminated
35or modified by court order or until 180 days following the date of
36the order, whichever event occurs earlier.

37
(i) Psychotropic medication or psychotropic drugs are those
38medications administered for the purpose of affecting the central
39nervous system to treat psychiatric disorders or illnesses. These
40medications include, but are not limited to, anxiolytic agents,
P26   1antidepressants, mood stabilizers, antipsychotic medications,
2anti-Parkinson agents, hypnotics, medications for dementia, and
3psychostimulants.

4
(j) (1) Psychotropic medications may be administered without
5court authorization to a child described in subdivision (a) in an
6emergency. An emergency exists if all of the following conditions
7are met:

8
(A) A physician finds that the child requires psychotropic
9medication to treat a psychiatric disorder or illness.

10
(B) The medication is immediately necessary for the preservation
11of life or the prevention of serious bodily harm to the child or
12others. It is not necessary for the harm to take place or become
13unavoidable prior to treatment.

14
(C) It is impractical to obtain authorization from the court
15before administering the psychotropic medication to the child.

16
(2) Court authorization shall be sought as soon as practical,
17but in no case more than two court days after the emergency
18administration of psychotropic medication.

19
(k) This section is not intended to supersede local court rules
20regarding a minor’s right to participate in mental health decisions.

21
(l) This section does not grant any person the authority to
22administer psychotropic medication to a child who indicates a
23refusal of treatment with the authorized medication. A person shall
24not threaten, coerce, withhold privileges, or otherwise penalize a
25child for refusing to take a psychotropic medication. A child
26described in subdivision (a) shall not be involuntarily administered
27a psychotropic medication unless otherwise specifically permitted
28by law.

29
(m) This section does not apply to nonminor dependents, as
30defined in subdivision (v) of Section 11400.

31
(n) (1) On or before January 1, 2018, the Judicial Council shall
32amend and adopt rules of court and develop appropriate forms
33for the implementation of this section, in consultation with the
34State Department of Social Services, the State Department of
35Health Care Services, and stakeholders, including, but not limited
36to, the County Welfare Directors Association of California, the
37County Behavioral Health Directors Association of California,
38the Chief Probation Officers of California, associations
39representing current and former foster children, caregivers, and
40children’s attorneys. This effort shall be undertaken in coordination
P27   1with the updates required under paragraph (1) of subdivision (n)
2of Section 739.5.

3
(2) The rules of court and forms developed pursuant to
4paragraph (1) shall address all of the following:

5
(A) The child and his or her caregiver and court-appointed
6special advocate, if any, have an opportunity to provide input on
7the medications being prescribed.

8
(B) Information regarding the child’s overall mental health
9assessment and treatment plan is provided to the court.

10
(C) Information regarding the rationale for the proposed
11medication, provided in the context of past and current treatment
12efforts, is provided to the court. This information shall include,
13but not be limited to, information on other pharmacological and
14nonpharmacological treatments that have been utilized and the
15child’s response to those treatments, a discussion of symptoms not
16alleviated or ameliorated by other current or past treatment efforts,
17and an explanation of how the psychotropic medication being
18prescribed is expected to improve the child’s symptoms.

19
(D) Guidance is provided to the court on how to evaluate the
20request for authorization, including how to proceed if information,
21otherwise required to be included in a request for authorization
22under this section, is not included in a request for authorization
23submitted to the court.

24
(3) The rules of court and forms developed pursuant to
25paragraph (1) shall include a process for periodic oversight by
26the court of orders regarding the administration of psychotropic
27medications that includes the caregiver’s and child’s observations
28regarding the effectiveness of the medication and side effects,
29information on medication management appointments and other
30followup appointments with medical practitioners, and information
31on the delivery of other mental health treatments that are a part
32of the child’s overall treatment plan. The periodic oversight shall
33be facilitated by the county social worker, public health nurse, or
34other appropriate county staff. This oversight process shall be
35conducted in conjunction with other regularly scheduled court
36hearings and reports provided to the court by the county child
37welfare agency.

38
(o) This section shall become operative on January 1, 2018.

end insert
39begin insert

begin insertSEC. 5.end insert  

end insert

begin insertSection 739.5 of the end insertbegin insertWelfare and Institutions Codeend insertbegin insert is
40amended to read:end insert

P28   1

739.5.  

(a) (1) If a minor who has been adjudged a ward of the
2court under Section 601 or 602 is removed from the physical
3custody of the parent under Section 726 and placed into foster
4care, as defined in Section 727.4, only a juvenile court judicial
5officer shall have authority to make orders regarding the
6administration of psychotropic medications for that minor. The
7juvenile court may issue a specific order delegating this authority
8to a parent upon making findings on the record that the parent
9poses no danger to the minor and has the capacity to authorize
10psychotropic medications. Court authorization for the
11administration of psychotropic medication shall be based on a
12request from a physician, indicating the reasons for the request, a
13description of the minor’s diagnosis and behavior, the expected
14results of the medication, and a description of any side effects of
15the medication.

16(2) (A) On or before July 1, 2016, the Judicial Council shall
17amend and adopt rules of court and develop appropriate forms for
18the implementation of this section, in consultation with the State
19Department of Social Services, the State Department of Health
20Care Services, and stakeholders, including, but not limited to, the
21County Welfare Directors Association of California, the County
22Behavioral Health Directors Association of California, the Chief
23Probation Officers of California, associations representing current
24and former foster children, caregivers, andbegin delete minor’send deletebegin insert minorsend insertbegin insertend insert
25 attorneys. This effort shall be undertaken in coordination with the
26updates required under paragraph (2) of subdivision (a) of Section
27369.5.

28(B) The rules of court and forms developed pursuant to
29subparagraph (A) shall address all of the following:

30(i) The minor and his or her caregiver and court-appointed
31special advocate, if any, have an opportunity to provide input on
32the medications being prescribed.

33(ii) Information regarding the minor’s overall mental health
34assessment and treatment plan is provided to the court.

35(iii) Information regarding the rationale for the proposed
36medication, provided in the context of past and current treatment
37efforts, is provided to the court. This information shall include,
38but not be limited to, information on other pharmacological and
39nonpharmacological treatments that have been utilized and the
40minor’s response to those treatments, a discussion of symptoms
P29   1not alleviated or ameliorated by other current or past treatment
2efforts, and an explanation of how the psychotropic medication
3being prescribed is expected to improve the minor’s symptoms.

4(iv) Guidance is provided to the court on how to evaluate the
5request for authorization, including how to proceed if information,
6otherwise required to be included in a request for authorization
7under this section, is not included in a request for authorization
8submitted to the court.

9(C) The rules of court and forms developed pursuant to
10subparagraph (A) shall include a process for periodic oversight by
11the court of orders regarding the administration of psychotropic
12medications that includes the caregiver’s and minor’s observations
13regarding the effectiveness of the medication and side effects,
14information on medication management appointments and other
15followup appointments with medical practitioners, and information
16on the delivery of other mental health treatments that are a part of
17the minor’s overall treatment plan. This oversight process shall be
18conducted in conjunction with other regularly scheduled court
19hearings and reports provided to the court by the county probation
20agency.

21(b) (1) The agency that completes the request for authorization
22for the administration of psychotropic medication is encouraged
23to complete the request within three business days of receipt from
24the physician of the information necessary to fully complete the
25request.

26(2) Nothing in this subdivision is intended to change current
27local practice or local court rules with respect to the preparation
28and submission of requests for authorization for the administration
29of psychotropic medication.

30(c) (1) Within seven court days from receipt by the court of a
31completed request, the juvenile court judicial officer shall either
32approve or deny in writing a request for authorization for the
33administration of psychotropic medication to the minor, or shall,
34upon a request by the parent, the legal guardian, or the minor’s
35attorney, or upon its own motion, set the matter for hearing.

36(2) Notwithstanding Section 827 or any other law, upon the
37approval or denial by the juvenile court judicial officer of a request
38for authorization for the administration of psychotropic medication,
39the county probation agency or other person or entity who
P30   1submitted the request shall provide a copy of the court order
2approving or denying the request to the minor’s caregiver.

3(d) Psychotropic medication or psychotropic drugs are those
4medications administered for the purpose of affecting the central
5nervous system to treat psychiatric disorders or illnesses. These
6medications include, but are not limited to, anxiolytic agents,
7antidepressants, mood stabilizers, antipsychotic medications,
8anti-Parkinson agents, hypnotics, medications for dementia, and
9psychostimulants.

10(e) Nothing in this section is intended to supersede local court
11rules regarding a minor’s right to participate in mental health
12decisions.

13(f) This section does not apply to nonminor dependents, as
14defined in subdivision (v) of Section 11400.

begin insert

15
(g) This section shall remain in effect only until January 1, 2018,
16and as of that date is repealed, unless a later enacted statute, that
17is enacted before January 1, 2018, deletes or extends that date.

end insert
18begin insert

begin insertSEC. 6.end insert  

end insert

begin insertSection 739.5 is added to the end insertbegin insertWelfare and Institutions
19Code
end insert
begin insert, to read:end insert

begin insert
20

begin insert739.5.end insert  

(a) If a minor who has been adjudged a ward of the
21court under Section 601 or 602 is removed from the physical
22custody of the parent under Section 726 and placed into foster
23care, as defined in Section 727.4, only a juvenile court judicial
24officer shall have authority to make orders regarding the
25administration of psychotropic medications for that minor. The
26juvenile court may issue a specific order delegating this authority
27to a parent, upon making findings on the record that the parent
28poses no danger to the minor and has the capacity to authorize
29psychotropic medications. Court authorization for the
30administration of psychotropic medication shall be based on a
31request from a physician, indicating the reasons for the request,
32a description of the minor’s diagnosis and behavior, the expected
33results of the medication, and a description of any side effects of
34the medication. If the court authorizes the administration of a
35psychotropic medication, it shall verify that the administration of
36the psychotropic medication is only one part of a comprehensive
37treatment plan for the minor that shall include and specify the
38psychosocial, behavioral, and alternative services, if any, the minor
39will receive in addition to any authorized medication.

P31   1
(b) (1) An order authorizing the administration of psychotropic
2medications pursuant to this section shall be granted only upon
3the court’s determination that the administration of the medication
4is in the best interest of the minor based on a determination that
5the anticipated benefits of the psychotropic medication outweigh
6the short- and long-term risks associated with the medications. An
7order authorizing the administration of psychotropic medication
8pursuant to this section shall not be granted if the court determines
9that the medication is being used as punishment, for purposes
10other than the treatment of a diagnosed mental health condition,
11as a substitute for other less invasive treatments, or in quantities
12or dosages that interfere with the minor’s treatment program.

13
(2) An order authorizing the administration of psychotropic
14medications pursuant to this section shall be granted only if the
15court determines all of the following:

16
(A) The court is provided documentation confirming the minor’s
17caregiver has been informed, and the minor has been informed in
18an age and developmentally appropriate manner in the primary
19language of the minor, about the recommended medications, the
20anticipated benefits, the nature, degree, duration, and probability
21of side effects and significant risks commonly known by the medical
22profession, and of psychosocial treatments and interventions
23specific to the identified disorder and symptoms to be considered
24concurrently with, or as an alternative to, the medication.

25
(i) The documentation shall state that the minor and the minor’s
26caregiver have been asked whether either have concerns regarding
27the medication, and, if so, shall describe the nature of those
28concerns.

29
(ii) The documentation shall confirm that the minor has been
30informed of the right to object to the authorization of psychotropic
31medication and to request a hearing pursuant to paragraph (1) of
32subdivision (g).

33
(iii) The documentation shall include the written consent or
34refusal to consent of a minor who is 12 years of age or older.

35
(B) The prescribing physician submitting the request for
36psychotropic medication was provided a copy of the child’s health
37and education summary or passport as described in Section 16010.

38
(C) The prescribing physician also confirms all of the following:

39
(i) There are no less invasive treatment options available to
40meet the needs of the minor.

P32   1
(ii) The dosage or dosage range requested is appropriate for
2the minor.

3
(iii) The short- and long-term risks associated with the use of
4psychotropic medications by the minor do not outweigh the
5reported benefits to the minor.

6
(iv) All appropriate measurements have been completed and
7all appropriate laboratory screenings or tests have been performed
8or ordered for the child in accordance with accepted medical
9guidelines.

10
(D) A plan is in place for regular monitoring of the minor’s
11medication and psychosocial treatment plan, the effectiveness of
12the medication and psychosocial treatment, and any potential side
13effects of the medication by the physician in consultation with the
14caregiver, mental health care provider, and others who have
15contact with the minor, as appropriate.

16
(3) The person or entity submitting the request for authorization
17of the administration of psychotropic medication is responsible
18for providing the necessary documentation of the clinical
19appropriateness of the proposed psychotropic medication and
20shall bear the burden of proof.

21
(c) (1) A court shall not issue an order authorizing the
22administration of psychotropic medications for a minor described
23in subdivision (a) unless a preauthorization review is obtained
24from a child psychiatrist or behavioral pediatrician, if one or more
25of the following circumstances exist:

26
(A) The request is for any class of psychotropic medication for
27a minor who is five years of age or younger.

28
(B) The request would result in the minor being administered
29three or more psychotropic medications concurrently.

30
(C) The request is for the concurrent administration of two
31antipsychotic medications unless the request is for medication
32tapering and replacement that is limited to no more than 45 days.

33
(2) Preauthorization review under this subdivision does not
34require a face-to-face assessment of the child for whom the
35psychotropic medications are prescribed. The court, on its own
36motion or upon the request of the child’s attorney or the parent
37or parent’s attorney, may order that assessment to be completed
38before deciding whether or not to approve the request to authorize
39the medication. The health care professional providing the
40preauthorization review shall review all the information submitted
P33   1to the court, including, but not limited to, the prescribing
2physician’s statement and the child’s health and education
3summary or passport, and, if deemed necessary, conduct a
4telephone consultation with the prescriber or the public health
5nurse responsible for the child pursuant to Section 16501.3.

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

13
(e) (1) No later than 60 days after the authorization of a new
14psychotropic medication is granted or at the next review hearing
15scheduled for a minor described in subdivision (a), if scheduled
16no earlier than 45 days after the authorization of a new
17psychotropic medication, the court shall conduct a review hearing
18to determine all of the following:

19
(A) Whether the minor is taking the medication or medications.

20
(B) Whether psychosocial services and other aspects of the
21minor’s treatment plan have been provided to the minor.

22
(C) To what extent the symptoms for which the medication or
23medications were authorized have been alleviated.

24
(D) Whether more time is needed to evaluate the effectiveness
25of the medication or medications.

26
(E) What, if any, adverse effects the minor has suffered.

27
(F) Any steps taken to address those effects.

28
(G) The date or dates of followup visits with the prescribing
29physician since the medication or medications were authorized.

30
(H) Whether the appropriate followup laboratory screenings
31have been performed and their findings.

32
(2) Prior to the review, the minor’s probation officer shall
33submit a report to the court and to counsel for the parties, which
34shall include information from the minor, the minor’s caregiver,
35the public health nurse, and the court-appointed special advocate,
36if any.

37
(3) If, based upon this review, the court determines that the
38proffered benefits of the medication have not been demonstrated
39or that the risks of the medication outweigh the benefits, the court
P34   1shall reconsider, modify, or revoke its authorization for the
2administration of medication.

3
(f) (1) The agency that completes the request for authorization
4for the administration of psychotropic medication is encouraged
5to complete the request within three business days of receipt from
6the physician of the information necessary to fully complete the
7request.

8
(2) Nothing in this subdivision is intended to change current
9local practice or local court rules with respect to the preparation
10and submission of requests for authorization for the administration
11of psychotropic medication.

12
(g) (1) Within seven court days from receipt by the court of a
13completed request, the juvenile court judicial officer shall either
14approve or deny in writing a request for authorization for the
15administration of psychotropic medication to the minor, refer the
16request for a preauthorization review as required by subdivision
17(c), or shall, upon a request by the parent, the legal guardian, or
18the minor’s attorney, or upon its own motion, set the matter for
19hearing.

20
(2) Notwithstanding Section 827 or any other law, upon the
21approval or denial by the juvenile court judicial officer of a request
22for authorization for the administration of psychotropic medication,
23the county probation agency or other person or entity who
24submitted the request shall provide a copy of the court order
25approving or denying the request to the minor’s caregiver.

26
(h) If the court grants the request, or modifies and grants the
27request, the order for authorization is effective until terminated
28or modified by court order or until 180 days following the date of
29the order, whichever event occurs earlier.

30
(i) Psychotropic medication or psychotropic drugs are those
31medications administered for the purpose of affecting the central
32nervous system to treat psychiatric disorders or illnesses. These
33medications include, but are not limited to, anxiolytic agents,
34antidepressants, mood stabilizers, antipsychotic medications,
35anti-Parkinson agents, hypnotics, medications for dementia, and
36psychostimulants.

37
(j) (1) Psychotropic medications may be administered without
38court authorization to a minor described in subdivision (a) in an
39emergency. An emergency exists if all of the following conditions
40are met:

P35   1
(A) A physician finds that the minor requires psychotropic
2medication to treat a psychiatric disorder or illness.

3
(B) The medication is immediately necessary for the preservation
4of life or the prevention of serious bodily harm to the minor or
5others. It is not necessary for the harm to take place or become
6unavoidable prior to treatment.

7
(C) It is impractical to obtain authorization from the court
8before administering the psychotropic medication to the minor.

9
(2) Court authorization shall be sought as soon as practical,
10but in no case more than two court days after the emergency
11administration of psychotropic medication.

12
(k) This section is not intended to supersede local court rules
13regarding a minor’s right to participate in mental health decisions.

14
(l) This section does not grant any person the authority to
15administer psychotropic medication to a minor who indicates a
16refusal of treatment with the authorized medication. A person shall
17not threaten, coerce, withhold privileges, or otherwise penalize a
18minor for refusing to take a psychotropic medication. A minor
19described in subdivision (a) shall not be involuntarily administered
20a psychotropic medication unless otherwise specifically permitted
21by law.

22
(m) This section does not apply to nonminor dependents, as
23defined in subdivision (v) of Section 11400.

24
(n) (1) On or before January 1, 2018, the Judicial Council shall
25amend and adopt rules of court and develop appropriate forms
26for the implementation of this section, in consultation with the
27State Department of Social Services, the State Department of
28Health Care Services, and stakeholders, including, but not limited
29to, the County Welfare Directors Association of California, the
30County Behavioral Health Directors Association of California,
31the Chief Probation Officers of California, associations
32representing current and former foster children, caregivers, and
33minors’ attorneys. This effort shall be undertaken in coordination
34with the updates required under paragraph (1) of subdivision (n)
35of Section 369.5.

36
(2) The rules of court and forms developed pursuant to
37paragraph (1) shall address all of the following:

38
(A) The minor and his or her caregiver and court-appointed
39special advocate, if any, have an opportunity to provide input on
40the medications being prescribed.

P36   1
(B) Information regarding the minor’s overall mental health
2assessment and treatment plan is provided to the court.

3
(C) Information regarding the rationale for the proposed
4medication, provided in the context of past and current treatment
5efforts, is provided to the court. This information shall include,
6but not be limited to, information on other pharmacological and
7nonpharmacological treatments that have been utilized and the
8minor’s response to those treatments, a discussion of symptoms
9not alleviated or ameliorated by other current or past treatment
10efforts, and an explanation of how the psychotropic medication
11being prescribed is expected to improve the minor’s symptoms.

12
(D) Guidance is provided to the court on how to evaluate the
13request for authorization, including how to proceed if information,
14otherwise required to be included in a request for authorization
15under this section, is not included in a request for authorization
16submitted to the court.

17
(3) The rules of court and forms developed pursuant to
18paragraph (1) shall include a process for periodic oversight by
19the court of orders regarding the administration of psychotropic
20medications that includes the caregiver’s and minor’s observations
21regarding the effectiveness of the medication and side effects,
22information on medication management appointments and other
23followup appointments with medical practitioners, and information
24on the delivery of other mental health treatments that are a part
25of the minor’s overall treatment plan. This oversight process shall
26be conducted in conjunction with other regularly scheduled court
27hearings and reports provided to the court by the county probation
28agency.

29
(o) This section shall become operative on January 1, 2018.

end insert
30begin insert

begin insertSEC. 7.end insert  

end insert
begin insert

Section 1.5 of this bill incorporates amendments to
31Section 4064.5 of the Business and Professions Code proposed by
32both this bill and Senate Bill 999. It shall only become operative
33if (1) both bills are enacted and become effective on or before
34January 1, 2017, (2) each bill amends Section 4064.5 of the
35Business and Professions Code, and (3) this bill is enacted after
36Senate Bill 999, in which case Section 1 of this bill shall not
37become operative.

end insert
38begin insert

begin insertSEC. 8.end insert  

end insert
begin insert

To the extent that this act has an overall effect of
39increasing the costs already borne by a local agency for programs
40or levels of service mandated by the 2011 Realignment Legislation
P37   1within the meaning of Section 36 of Article XIII of the California
2Constitution, it shall apply to local agencies only to the extent that
3the state provides annual funding for the cost increase. Any new
4program or higher level of service provided by a local agency
5pursuant to this act above the level for which funding has been
6provided shall not require a subvention of funds by the state or
7otherwise be subject to Section 6 of Article XIII B of the California
8Constitution.

end insert


O

    91