BILL ANALYSIS Ó
SB 253
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Date of Hearing: August 19, 2015
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Jimmy Gomez, Chair
SB 253
(Monning) - As Amended July 8, 2015
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Urgency: No State Mandated Local Program: YesReimbursable:
Yes
SUMMARY: This bill modifies juvenile court practices and
requirements, as of July 1, 2016, regarding the authorization of
psychotropic medications for foster youth. Specifically, this
bill:
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1)Requires the court, whenever it authorizes the administration
of a psychotropic medication, to ensure that such
administration is only one part of a comprehensive treatment
plan for the child, as specified, there is clear and
convincing evidence that such administration is in the best
interest of the child, as specified, and court has made
specified determinations regarding, among other items,
consent, treatment options, dosage appropriateness, risks and
benefits, completion of laboratory screenings and tests, and
the existence of a follow up plan to monitor the child's
treatment.
2)Prohibits a court from issuing an order authorizing the
administration of psychotropic medications without a second
independent medical opinion under certain conditions.
3)Prohibits the court from authorizing the administration of
psychotropic medication unless the court receives
documentation indicating that all appropriate laboratory
screenings, measurements, or tests have been completed no more
than 45 days prior to the submission of the request to the
court, as specified.
4)Requires the child's social worker to submit a report to the
court and to counsel for the parties prior to the review
hearing that includes information from the child, the child's
caregiver, the public health nurse, and any court appointed
special advocate.
5)Requires the Judicial Council to adopt rules and develop
appropriate forms by July 1, 2016.
FISCAL EFFECT:
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1)Potentially major increase in Medi-Cal program costs up to the
low millions of dollars (Federal Funds/GF) 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.
2)Annual costs of about $1.3 million (Federal Fund/GF) 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 45 days
from the date of the request to the court, and attend the
additional review hearings.
3)Annual costs, ranging from $0.9 million to $1.8 million (GF),
for review hearings for approximately 9,000 requests for
psychotropic medication authorizations each year.
4)Annual costs of around $1 million (GF) for document management
related to approximately 9,000 requests for psychotropic
medication authorizations per year.
5)One-time costs of $77,000 (GF) to the Judicial Council to
develop/revise forms and rules.
6)Potentially significant off-setting decrease in Medi-Cal
program costs (Federal Funds/GF) 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
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offsetting costs.
COMMENTS:
1)Purpose. This is one of four bills proposing a set of reforms
aimed at curbing excessive and inappropriate authorization and
administration of psychotropic medications among foster youth.
The author states, "Since 1999, juvenile courts have been the
decision-makers and the gatekeepers for authorizing
psychotropic medications for children in foster care. But we
have not given the courts standards by which to guide their
decision-making and the support necessary to make an informed
decision. This bill ensures our juvenile court judges are
given the information they need to make informed decisions
before authorizing these medications, provides criteria to
guide the decision-making, and safeguards our foster
children's health and safety by overseeing the effects of
these medications."
2)Background. Existing law provides that only a juvenile court
judicial officer has the authority to make orders regarding
the administration of psychotropic medications for a minor who
is a dependent of the court and has been removed from the
physical custody of his or her parent. Existing law also
requires the Judicial Council to adopt rules and develop
appropriate forms.
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,
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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.
Research has repeatedly indicated that children and youth in
foster care face higher levels of inappropriate or excessive
medication use, and that those foster youth placed in group
home settings are particularly vulnerable to over-prescription
and misuse of psychotropic medications. Data provided by the
Department of Health Care Services (DHCS) indicate that, in
fiscal year 2013-14, almost 15% of all foster youth in
California ages 0 to 20 years old were prescribed at least one
psychotropic medication; for foster youth ages 12 through 20,
this rate was almost 25% and for youth placed in group homes,
it was 50%.
3)Arguments in Support. The National Center for Youth Law,
states that, "When more than twenty-five percent of older
children and adolescents in foster care are given one or more
psychotropic medications, and thousands of children are taking
multiple drugs at the same time, when fifty percent of those
foster children receiving a psychotropic medication are
administered an antipsychotic, it is clear that the current
system is failing our children. A more rigorous process is
needed to protect the health and welfare of our foster
children. We believe [this bill] will improve decision-making
for our children and provide the protections they are entitled
to before being given medications that have profound effects
upon their well-being."
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4)Concerns. Various parties, some representing health care
providers, have registered concerns claiming the bill's
provisions may actually restrict timely access to medically
necessary medications for children. For example, they point
to unrealistic requirements of a prescribing physician that
involve data and information they must access or provide that
may not be available, thus making confirmation of medical
record review and least invasive modality of treatment
difficult. They also are concerned that second opinion
requirements will result in delays in treatment due to the
lack of qualified physicians, especially in rural counties, as
well as the feasibility of receiving completed labs under the
required timeframes.
5)Related Legislation. The following bills are part of a
four-bill package (including this bill) regarding the use of
psychotropic medication for children in foster care. All are
before this Committee today.
a) SB 238 (Mitchell) requires DSS to develop expanded
training for foster parents, social workers, group home
administrators, and others involved in the care and
oversight of dependent children on issues related to
psychotropic medications.
b) SB 319 (Beall) adds to the duties of foster care public
health nurses, including monitoring each child in foster
care who is administered one or more psychotropic
medications.
c) SB 484 (Beall) requires DSS to compile and post on its
Internet Web site specified information regarding the
administration of psychotropic medications to children
placed in group homes and to establish a methodology for
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identifying group homes with high levels of psychotropic
drug use. Further establishes certain requirements for
those group homes.
Analysis Prepared by:Jennifer Swenson / APPR. / (916)
319-2081