BILL ANALYSIS Ó
SENATE COMMITTEE ON APPROPRIATIONS
Senator Ricardo Lara, Chair
2015 - 2016 Regular Session
SB 253 (Monning) - Dependent children: psychotropic medication
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|Version: May 5, 2015 |Policy Vote: HUMAN S. 5 - 0, |
| | JUD. 6 - 0 |
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|Urgency: No |Mandate: No |
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|Hearing Date: May 18, 2015 |Consultant: Jolie Onodera |
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This bill meets the criteria for referral to the Suspense File.
Bill
Summary: SB 253 would provide that an order of the juvenile
court authorizing psychotropic medication shall require clear
and convincing evidence of specified conditions. This bill
prohibits the authorization of psychotropic medications without
a second independent medical opinion under specified
circumstances. It also prohibits the authorization of
psychotropic medications unless the court is provided
documentation that appropriate lab screenings, measurements, or
tests have been completed, as specified.
Fiscal
Impact:
Judicial Council Forms/Rules of court : One-time costs of
$77,000 (General Fund*).
Additional review hearings : Annual costs ranging from $0.9
million to $1.8 million (General Fund*) for review hearings
for approximately 9,000 requests for psychotropic medication
authorizations each year (based on match of CWS/CMS data with
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DHCS pharmacy claims from FFY 2013).
Document management : Annual costs of about $1 million
(General Fund*) for approximately 9,000 requests for
psychotropic medication authorizations per year.
Child welfare services : Annual costs of about $1.3 million
(Federal Fund/General Fund**) for social workers to identify
cases that require a second opinion, make arrangements for the
youth to be examined by the second medical practitioner,
ensure the child's screenings, lab tests, and measurements
have occurred no more than 30 days from the date of the
request to the court, and attend the additional review
hearings.
Medical examinations, lab screenings, tests : Potentially
major increase in Medi-Cal program costs in the low millions
of dollars (Federal Funds/General Fund) annually to the extent
the provisions of this measure result in additional medical
examinations for second opinions, as well as an increase in
lab screenings, measurements, and tests completed that
otherwise would not occur under existing law. While the
estimated costs for second medical opinions may be less than
$1 million annually as it will not impact the entire caseload,
the requirement to have all appropriate lab screenings and
tests within 30 days prior to submission of the request to the
court will be required for each authorization.
Psychotropic medication authorizations : Potentially
significant off-setting decrease in Medi-Cal program costs
(Federal Funds/General Fund) to the extent the enhanced
oversight and monitoring process results in reduced
utilization of psychotropic medications for this population of
youth. To the extent the reduced utilization of these
medications are replaced with alternative treatment
options/psychosocial services could result in additional
offsetting costs.
Proposition 30** : Exempts the State from mandate
reimbursement for realigned programs, however, legislation
that has an overall effect of increasing the costs already
borne by a local agency for realigned programs, including
child welfare services, apply to local agencies only to the
extent that the State provides annual funding for the cost
increase.
*Trial Court Trust Fund
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Background: Existing law provides that only a juvenile court judicial
officer shall have authority to make orders regarding the
administration of psychotropic medications for a minor who has
been adjudged a dependent of the court and removed from the
physical custody of his or her parent. Existing law also
requires the Judicial Council to adopt rules of court and
develop appropriate forms. (Welfare and Institutions Code §
369.5.)
Pursuant to Rule of Court 5.640, the prescribing physician is
required to complete and submit an application to the court,
known as the "JV-220" form. The JV-220 requires the inclusion of
specific information, including: (1) the child's diagnosis; (2)
the specific medication with the recommended maximum daily
dosage and length of time this course of treatment will
continue; (3) the anticipated benefits to the child from the use
of the medication; (4) a list of any other medications,
prescription or otherwise, that the child is currently taking,
and a description of any effect these medications may produce in
combination with the psychotropic medication; and (5) a
statement that the child has been informed in an age-appropriate
manner of the recommended course of treatment, the basis for it,
and its possible results. The court is required, upon review of
the JV-220, to deny, grant, or modify the application for
authorization of psychotropic medication within seven days, or
to set the matter for hearing. The court may also set a date for
review of the child's progress and condition.
As noted in the recent analysis of this measure by the Senate
Committee on Judiciary (April 28, 2015):
Governing magazine recently noted that children in
the United States are on drugs for longer and more
often than kids in any other country. (Chris
Kardish, Bad Medicine: How states are
overmedicating low-income kids, Governing, March
2015.) Much of the concern stems from the fact that
the long-term effects of psychotropic drugs on
children are unknown, and the short term effects,
including obesity, diabetes, and tremors, can be
debilitating. Yet, many medical and child welfare
professionals agree that some foster youth may
benefit from these medications at some point in
their lives. These children, who have suffered
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abuse and neglect at the hands of family, often
have clinically significant emotional or behavioral
problems. However, when psychotropic medications
are prescribed to a foster child whose parent has
been found, at least temporarily, unfit to approve
the administration of the drugs, the question
arises as to whether the court is capable of making
the important inquiries that a parent should make
before administering any medication to his or her
child. (p.2)
Proposed Law:
This bill requires the Judicial Council to adopt rules of court
and develop appropriate forms for implementation on or before
July 1, 2016, of the following:
Provides that whenever the court authorizes the
administration of a psychotropic medication, it shall
ensure that the administration of the psychotropic
medication is only one part of a comprehensive treatment
plan for the child that shall include and specify the
psychosocial services the child will receive in addition to
any authorized medication.
Requires an order authorizing the administration of
psychotropic medications to only be granted on clear and
convincing evidence that administration of the medication
is in the best interest of the child, as specified.
Provides that an order authorizing the administration of
psychotropic medications shall only be granted if the court
determines all of the following:
o The court is provided documentation confirming the
child's caregiver has been informed, and the child has
been informed in an age and developmentally appropriate
manner, about the recommended medications, the
anticipated benefits, the nature, degree, duration, and
probability of side effects and significant risks
commonly known by the medical profession, and of
psychosocial treatments to be considered concurrently
with or as an alternative to the medication.
o The prescribing physician submitting the request
for psychotropic medication confirms that he or she
conducted a comprehensive examination of the child.
o Requires the prescribing physician to also confirm
there are no less invasive and effective treatment
options available to meet the needs of the child.
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A plan is in place for regular monitoring of the child's
medication and psychosocial treatment plan, the
effectiveness of the medication and psychosocial treatment,
and any potential side effects of the medication, by the
physician in consultation with the caregiver, mental health
care provider, and others who have contact with the child,
as appropriate.
Prohibits a court from issuing an order authorizing the
administration of psychotropic medications for a child
unless a second independent medical opinion is obtained
from a child psychiatrist or a psychopharmacologist if one
or more of specified circumstances exist.
Prohibits a court from authorizing the administration of
the psychotropic medication unless the court is provided
documentation that all of the appropriate lab screenings,
measurements, or tests for the child have been completed in
accordance with accepted medical guidelines no more than 30
days prior to submission of the request to the court.
Requires a review hearing no later than 60 days after
the authorization of a new psychotropic medication is
granted or at the next review hearing scheduled for the
child, as specified, if scheduled no earlier than 45 days
after the authorization of a new psychotropic medication to
determine:
o Whether the child is taking the medication or
medications.
o Whether psychosocial services and other
aspects of the child's treatment plan have been
provided to the child.
o To what extent the symptoms for which the
medication or medications were authorized have been
alleviated.
o Whether more time is needed to evaluate the
effectiveness of the medication or medications.
o What, if any, adverse effects the child has
suffered.
o The date or dates of follow-up visits with the
prescribing physician since the medication or
medications were authorized.
Provides that if based upon this review, the court
determines that the proffered benefits of the medication
have not been demonstrated or that the risks of the
medication outweigh the benefits, the court shall
reconsider, modify, or revoke its authorization for the
administration of medication.
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Provides that psychotropic medications may be
administered without court authorization in an emergency,
as specified.
Related
Legislation: SB 238 (Mitchell) 2015 would require additional
training, oversight, and data collection and reporting by
specified entities involved in the process of the administration
of psychotropic medication in the foster care system. This bill
would require the Judicial Council, on or before July 1, 2016,
in consultation with various stakeholders, to develop updates to
the forms required to implement the bill's provisions, as
specified. This bill is pending on the Suspense File of this
Committee.
SB 319 (Beall) 2015 would expand the duties of the foster care
public health nurse (PHN) to include monitoring and oversight of
the administration of psychotropic medication to foster
children, as specified. It also requires counties to provide
child welfare PHN services by contracting with the community
child health and disability prevention program established by
the county. This bill is scheduled to be heard today in this
Committee.
SB 484 (Beall) 2015 would require DSS to publish and make
available to interested persons specified information regarding
the administration of psychotropic medication in residential
facilities serving dependent children. Additionally, it requires
DSS to inspect facilities at least once per year if the facility
is determined to have a higher than average rate of psychotropic
medication authorization for children residing in the facility
and to monitor corrective action plans, as specified. This bill
is scheduled to be heard today in this Committee.
Staff
Comments: This bill strengthens the oversight and monitoring
process of the administration of psychotropic medications to
foster care youth. This bill imposes new activities on the
courts and social workers that will increase workload costs on
an ongoing basis as reflected in the Fiscal Impact section of
this analysis. This bill is also estimated to result in both
increases and decreases in Medi-Cal program costs: cost
increases for additional medical examinations, lab screenings,
and tests prior to medication authorization, and cost decreases
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to the extent the enhanced oversight and monitoring results in
the reduced utilization of these medications.
Proposition 30, passed by the voters in November 2012, among
other provisions, eliminated any potential mandate funding
liability for any new program or higher level of service
provided by counties related to realigned programs. Although the
provisions increasing social worker activities are a mandate on
local agencies, any increased costs would not be subject to
reimbursement by the state. Rather, Proposition 30 specifies
that for legislation enacted after September 30, 2012, that has
an overall effect of increasing the costs already borne by a
local agency for realigned programs such as child welfare
services, the provisions shall apply to local agencies only to
the extent that the state provides annual funding for the cost
increase.
While the potential costs of this measure are substantial, the
provision of increased monitoring and oversight over the process
of the authorization of psychotropic medications would promote
further protection of the health and well-being of youth in the
child welfare system, and ultimately result in more positive
long-term outcomes for these youth.
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