BILL ANALYSIS Ó
SB 253
Page 1
SENATE THIRD READING
SB
253 (Monning)
As Amended August 31, 2015
Majority vote
SENATE VOTE: 40-0
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|Committee |Votes|Ayes |Noes |
| | | | |
| | | | |
| | | | |
|----------------+-----+----------------------+--------------------|
|Judiciary |10-0 |Mark Stone, Wagner, | |
| | |Alejo, Chau, Chiu, | |
| | |Gallagher, | |
| | | | |
| | | | |
| | |Cristina Garcia, | |
| | |Holden, Maienschein, | |
| | |O'Donnell | |
| | | | |
|----------------+-----+----------------------+--------------------|
|Human Services |7-0 |Chu, Mayes, Calderon, | |
| | |Lopez, Maienschein, | |
| | |Mark Stone, Thurmond | |
| | | | |
|----------------+-----+----------------------+--------------------|
|Appropriations |12-0 |Gomez, Bloom, Bonta, | |
| | |Calderon, Nazarian, | |
SB 253
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| | |Eggman, Eduardo | |
| | |Garcia, Holden, | |
| | |Quirk, Rendon, Weber, | |
| | |Wood | |
| | | | |
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SUMMARY: Revises and strengthens, as of July 1, 2016, juvenile
court oversight requirements for administration of psychotropic
medications to wards and dependents. Specifically, this bill:
1)Requires the court to verify, when authorizing administration
of a psychotropic medication, that the medication is only one
part of a comprehensive treatment plan for the child, which
must specify the psychosocial services the child will receive
in addition to any authorized medication.
2)Allows the juvenile court to authorize psychotropic medication
to a ward or dependent only if the court determines that
administration of the medication is in the best interest of
the child based on a determination that the anticipated
benefits of the psychotropic medication outweigh the short-
and long-term risks associated with it. Provides that the
medication cannot be ordered if it is being used as a
punishment, for purposes other than treatment of a diagnosed
mental health condition, as a substitute for less invasive
treatments, or in quantities that interfere with the child's
treatment program. Provides that the authorization is
effective for no more than 180 days.
3)Provides that an order authorizing psychotropic medication
shall only be granted if the court:
a) Is provided documentation confirming the child's
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caregiver and the child have been informed, in an age and
developmentally appropriate manner, about the recommended
medications and asked about their concerns, and the child
has been informed of his or her right to object to the
authorization and request a hearing.
b) Is provided with the written assent or refusal to assent
from a child who is 12 years of age or older.
c) Determines that the medication is not being used as
punishment, for purposes other than treatment of a
diagnosed mental health condition, as a substitute for less
invasive treatments, or in quantities or dosages that
interfere with the child's treatment program.
d) Determines that the prescribing physician has conducted
a comprehensive examination of the child, as defined, and
confirm that there are no less invasive and effective
treatment options available to meet the child's needs; the
dosage is appropriate for the child; the short- and
long-term risks do not outweigh the benefits of the
medication; and all appropriate lab screenings for the
child have been completed.
e) Determines that 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.
4)Prohibits the authorization of psychotropic medications
without a second medical opinion by a specified health care
professional in any of the following circumstances:
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a) The child is five years old or less;
b) The request would result in the child receiving three or
more psychotropic medications concurrently; or
c) The request is for concurrent medication of two
antipsychotic medications.
5)Requires the Department of Health Care Services, in
collaboration with the Judicial Council, to assist courts in
securing second opinions in those counties with fewer than ten
practicing child and adolescent psychiatrists in order to
avoid undue delays in authorization of medication.
6)Prohibits the court from authorizing the administration of
psychotropic medications unless it is provided documentation
that the appropriate lab tests, done no more than 45 days
prior to the submission of the request, have been completed.
7)Requires the court, no later than 60 days following an
authorization for a new psychotropic medication, or at the
next review hearing scheduled no earlier than 45 days after
the authorization, to conduct a review hearing. Requires the
social worker to submit a report prior to the review hearing.
Requires the court to reconsider, modify or revoke its
authorization if it determines that the proffered benefits of
the medication have not been demonstrated or that the risks of
the medication outweigh the benefits.
8)Allows a psychotropic medication to be administrated without
court authorization in an emergency, provided that court
authorization is sought as soon as practical, but no more than
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two court days after administering the medication and all of
the following are true:
a) The physician finds that the child requires the
medication to treat a psychiatric disorder or illness;
b) The medication is immediately necessary for the
preservation of life or prevention of serious bodily harm
for the child or others; and
c) It is impractical to obtain court approval prior to
administering the medication.
9)Provides that nothing in the bill grants anyone the authority
to administer psychotropic medication to a child who refuses
to take the medication. Provides that no person may threaten,
coerce, withhold privileges or otherwise penalize a child for
refusing to take psychotropic medication. A child cannot be
involuntarily administered a psychotropic medication unless
otherwise specifically permitted.
EXISTING LAW:
1)Provides that a minor may be removed from the physical custody
of his or her parents and become a dependent of the juvenile
court as the result of abuse or neglect.
2)Provides that a juvenile court has jurisdiction over a child
when that child has committed acts that trigger delinquency
jurisdiction rendering the child a ward.
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3)Authorizes the court to make any and all reasonable orders for
the care, supervision, custody, conduct, maintenance and
support of a dependent child, including medical treatment.
4)Authorizes the court to allow a social worker or probation
officer to authorize the medical, surgical, dental or other
remedial care for a ward or dependent child who has been
placed by the court under the custody or supervision of a
social worker or probation officer, if it appears there is no
parent or guardian capable of authorizing or willing to
authorize medical, surgical, dental or other care.
5)Authorizes a minor who is 12 years of age or older to consent
to mental health treatment or counseling services if, in the
opinion of the attending professional person, the minor is
mature enough to participate intelligently in the mental
health treatment or counseling services.
6)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 or ward of the court and removed from the physical
custody of his or her parent. Defines "psychotropic medicine"
as those medicines administered to treat psychiatric disorders
or illnesses and includes anxiolytic agents, antidepressants,
mood stabilizers, antipsychotic medications, anti-Parkinson
agents, hypnotics, medications for dementia and
psychostimulants.
7)Requires court authorization for the administration of
psychotropic medication to be based on a request from a
physician, indicating the reasons for the request, a
description of the minor's diagnosis and behavior, the
expected results of the medication and a description of any
side effects of the medication. Requires, within seven court
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days, the juvenile court to either approve or deny in writing
a request for authorization for the administration of
psychotropic medication, or to set the matter for hearing.
Requires the Judicial Council to adopt rules of court and
develop appropriate forms.
FISCAL EFFECT: According to the Assembly Appropriations
Committee:
1)Potentially major increase in Medi-Cal program costs up to the
low millions of dollars (Federal Funds/General Fund (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 $1.0 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 $1 million to $2 million (GF), for
review hearings for approximately 10,000 requests for
psychotropic medication authorizations each year.
4)Annual costs of around $1 million (GF) for document management
related to approximately 10,000 requests for psychotropic
medication authorizations per year.
5)One-time costs of $77,000 (GF) to the Judicial Council to
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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
offsetting costs.
COMMENTS: This bill is part of a package of bills introduced in
response to very troubling, recent reports on the overmedicating
of children in the juvenile court system with psychotropic
drugs. Psychotropic medication alters chemical levels in the
brain which impact mood and behavior and includes
antipsychotics, antidepressants and psychostimulants. The
category of psychotropic medication is fairly broad, intending
to treat symptoms of conditions ranging from ADHD to childhood
schizophrenia. Much of the use of psychotropic drugs in
children is considered "off label," meaning the use has not been
approved by the Food and Drug Administration (FDA) for the
prescribed use, though the practice is legal and common across
all manner of pharmaceuticals.
This comprehensive bill seeks to improve ongoing juvenile court
oversight by providing a detailed framework the court must use
when determining whether to approve the administration of
psychotropic medication to wards and foster children, and
requires judicial oversight of any ongoing treatment to help
ensure that these powerful drugs are only used when medically
necessary and appropriate for the particular child and that such
usage is very carefully monitored to ensure any benefits of the
medication are not outweighed by its short- and long-term risks.
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Analysis Prepared by:
Leora Gershenzon / JUD. / (916) 319-2334 FN:
0001622