BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | SB 253|
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VETO
Bill No: SB 253
Author: Monning (D), et al.
Amended: 8/4/16
Vote: 21
SENATE HUMAN SERVICES COMMITTEE: 5-0, 4/21/15
AYES: McGuire, Berryhill, Hancock, Liu, Nguyen
SENATE JUDICIARY COMMITTEE: 6-0, 4/28/15
AYES: Jackson, Anderson, Hertzberg, Leno, Monning, Wieckowski
NO VOTE RECORDED: Moorlach
SENATE APPROPRIATIONS COMMITTEE: 7-0, 5/28/15
AYES: Lara, Bates, Beall, Hill, Leyva, Mendoza, Nielsen
SENATE FLOOR: 40-0, 6/3/15
AYES: Allen, Anderson, Bates, Beall, Berryhill, Block,
Cannella, De León, Fuller, Gaines, Galgiani, Glazer, Hall,
Hancock, Hernandez, Hertzberg, Hill, Hueso, Huff, Jackson,
Lara, Leno, Leyva, Liu, McGuire, Mendoza, Mitchell, Monning,
Moorlach, Morrell, Nguyen, Nielsen, Pan, Pavley, Roth, Runner,
Stone, Vidak, Wieckowski, Wolk
SENATE FLOOR: 34-5, 8/24/16
AYES: Allen, Beall, Berryhill, Block, Cannella, De León,
Galgiani, Glazer, Hall, Hancock, Hernandez, Hertzberg, Hill,
Hueso, Huff, Jackson, Lara, Leno, Leyva, Liu, McGuire,
Mendoza, Mitchell, Monning, Moorlach, Morrell, Nguyen, Pan,
Pavley, Roth, Stone, Vidak, Wieckowski, Wolk
NOES: Anderson, Bates, Fuller, Gaines, Nielsen
ASSEMBLY FLOOR: 75-0, 8/18/16 - See last page for vote
SUBJECT: Juveniles: psychotropic medication
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SOURCE: National Center for Youth Law
DIGEST: This bill requires that, beginning January 1, 2018, 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
laboratory screenings, as specified. This bill also requires
that under specified conditions the court be prohibited from
authorizing psychotropic medications until a pre-authorization
review has been conducted by a child psychiatrist or behavioral
pediatrician, as specified. This bill imposes additional court
oversight requirements, as specified, and includes chaptering
amendments to resolve conflicts with SB 999 (Pavley).
ANALYSIS:
Existing law:
1) Establishes a system of juvenile dependency for children who
are or are at risk of being physically, sexually or
emotionally abused, being neglected or being exploited to
ensure their safety, protection and physical and emotional
well-being, and further establishes a juvenile court's
jurisdiction over a child when that child has committed acts
that trigger delinquency jurisdiction.
2) 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.
3) Authorizes the court to allow a social worker or probation
officer to authorize medical, surgical, dental or other
remedial care for a ward or dependent child who has been
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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.
4) 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.
5) Establishes that only a juvenile court judicial officer has
authority to make orders about 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 medicines used to treat psychiatric disorders or
illnesses, as specified.
6) 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
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.
7) Requires the Judicial Council to adopt rules of court and
develop appropriate forms to ensure the child and caregiver
have an opportunity to provide input on the medications being
prescribed, that information about the child's overall mental
health assessment and treatment plan is provided to the
court, including the rationale for the proposed medication
and guidance about how to evaluate the request for
authorization and oversight mechanisms.
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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 include and specify the psychosocial, behavioral and
alternative services the child will receive in addition to
any medication.
2) Prohibits the juvenile court from authorizing psychotropic
medication to a ward or dependent unless it 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 the medications.
3) Prohibits authorizing the administration of psychotropic
medication if the court determines 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.
4) Permits an order authorizing psychotropic medication to be
granted only if:
a) The court is provided documentation confirming the
child's caregiver and the child have been informed, in an
age and developmentally appropriate manner, about the
recommended medications and side-effects 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) The court is provided with the written consent or
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refusal to assent from a child who is 12 years of age or
older.
c) The court determines that the prescribing physician
was provided a copy of the child's health and education
summary or passport, and confirms 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 performed or ordered.
d) The court 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 treatment, and any potential side effects
of the medication.
5) Prohibits the authorization of psychotropic medications
without a preauthorization review, as defined, from a child
psychiatrist or behavioral pediatrician if the child is five
years old or less, or the request would result in the child
receiving three or more psychotropic medications
concurrently, or the request is for concurrent medication of
two antipsychotic medications, unless the request is for
medication tapering, as specified.
6) Establishes that preauthorization review, as specified, does
not require a face-to-face assessment of the child for whom
the psychotropic medications are prescribed, but permits the
court to order that assessment to be completed before
deciding whether or not to approve the request to authorize
the medication, as specified.
7) Prohibits the court from authorizing the administration of
psychotropic medications unless it is provided documentation
that the appropriate lab tests have been completed, as
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specified.
8) 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 to determine:
a) Whether the child is taking the medication or
medications.
b) Whether psychosocial services and other aspects of the
child's treatment plan have been provided to the child.
c) To what extent the symptoms for which the medication
or medications were authorized have been alleviated and
what, if any, adverse effects the child has suffered and
any steps to address those effects.
d) Whether more time is needed to evaluate the
effectiveness of the medication or medications.
e) The date or dates of follow-up visits with the
prescribing physician since the medication or medications
were authorized and whether appropriate follow-up
laboratory screenings have been performed, and their
findings.
9) 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.
10) Allows a psychotropic medication to be administrated
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without court authorization in an emergency, provided that
court authorization is sought as soon as practical, as
specified, 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.
11) Establishes 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, and specifies that a child cannot be
involuntarily administered a psychotropic medication unless
otherwise specifically permitted by law.
12) Establishes various timelines for reports, adoption of
rules, updates to appropriate forms, as specified, and other
implementation efforts.
Background
Concern over the use of psychotropic medications among children
has been well-documented in research journals and the mainstream
media for more than a decade. The category of psychotropic
medication is broad, intending to treat symptoms of conditions
ranging from attention deficit hyperactivity disorder (ADHD) to
childhood schizophrenia. Some of the drugs used to treat these
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conditions are U.S. Food and Drug Administration (FDA)-approved,
including stimulants like Ritalin for ADHD, however only about
31 percent of psychotropic medications have been approved by the
FDA for use in children or adolescents. Anti-psychotic
medications, used to treat more severe mental health conditions,
have very limited approval by the FDA for pediatric use.
However, the off-label use of anti-psychotics is high,
particularly among foster children.
According to a study published in 2011, children who took
antipsychotic medications were likely to suffer ill health
effects including "cardio metabolic and endocrine side-effects"
as well as significant weight gain. Compounding the potential
for unintended side effects is the use of combinations of
psychotropic medications, which foster youth are particularly
likely to be prescribed. Protecting the health and well-being of
children who are taking one or more psychotropic medications
requires ongoing health and metabolic screenings to identify
potential adverse effects quickly, however in practice many
children fail to receive ongoing screenings and effects may go
undetected, causing permanent injury or death.
Newspaper articles over the past two years have identified
concerns that psychotropic medications have been used as a means
of controlling, instead of treating, foster youth who suffer
from trauma-related behavioral health challenges. A series of
articles in the San Jose Mercury News identified prescribing
rates, dosages and regimens that concerning to child welfare
system experts. A package of bills in 2015 and this year have
sought to increase oversight of prescribing to foster youth and
ensure the use of other therapies to address behavioral issues.
Court oversight mechanisms. Once a child has been adjudged a
dependent of the state, only the court may authorize
psychotropic medications for the child, based on a request from
a physician that includes a description of the child's diagnosis
and behavior, the expected results of the medication and a
description of any medication side effects. The Administrative
Office of the Courts established a series of court documents
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generally referred to as "the" JV-220, which includes a
statement completed and signed by the prescribing physician that
includes the child's diagnosis, relevant medical history, other
therapeutic services, the medication to be administered, and the
basis for the recommendation.
Oversight concerns. A broad range of stakeholders have expressed
concerns with the efficacy of current oversight mechanisms
citing the limited scope of information that is available on the
JV-220 and a lack of access to medical experts able to assist in
evaluating medical information. Frequent placement changes of
dependent youth may mean that important medical history does not
accompany the youth and that some medication regimens, may not
be disclosed to a judge, prescribing physician, social worker or
caregiver.
FISCAL EFFECT: Appropriation: No Fiscal
Com.:YesLocal: Yes
According to the Assembly Appropriations Committee, this bill
will result in a 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 bill
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. Additionally, the Committee identified annual costs of
about $1 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.
This bill also will result in costs of $1 million to $2 million
(GF) annually, for review hearings for approximately 10,000
requests for psychotropic medication authorizations each year,
and annual costs of around $1 million (GF) for document
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management related to approximately 10,000 requests for
psychotropic medication authorizations per year. This bill also
will result in one-time costs of $77,000 (GF) for the Judicial
Council to develop or revise forms and rules.
The Committee also identified 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.
SUPPORT: (Verified 10/11/16)
National Center for Youth Law (source)
Advokids
AFSCME
Alameda County Board of Supervisors
Alameda County Foster Youth Alliance
California Court Appointed Special Advocates Association
California State Department of Justice
California Youth Connection
Children's Advocacy Institute
Children's Partnership
Consumer Watchdog
County Welfare Directors Association of California
Court Appointed Special Advocates of Santa Cruz County
Dependency Legal Group of San Diego
Disability Rights California
East Bay Children's Law Offices
East Bay Community Law Center
First Focus Campaign for Children
Humboldt County Transition Age You Collaboration
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John Burton Foundation for Children Without Homes
Judicial Council of California
Kidsave
Legal Advocates for Children and Youth
National Association of Social Workers
Peers Envisioning and Engaging in Recovery Services
San Luis Obispo County Department of Social Services
Sunny Hills Services
United Advocates for Children and Families
Youth Law Center
10 individuals
OPPOSITION: (Verified10/11/16)
California Academy of Child and Adolescent Psychiatry
California Alliance
California Medical Association
California Psychiatric Association
County Behavioral Health Directors Association
ARGUMENTS IN SUPPORT: The National Center for Youth Law writes
that while courts have been gatekeepers to authorize
psychotropic medications for foster children, the courts have
not had adequate standards to guide decision making. "When more
than 25 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 ? it is
clear that the current system is failing our children."
ARGUMENTS IN OPPOSITION: A joint letter from the California
Medical Association, County Behavioral Health Directors
Association, California Psychiatric Association, California
Academy of Child and Adolescent Psychiatry and the California
Alliance cite a number of concerns. Specifically, they argue the
bill does not provide resources for preauthorization reviews and
changes or adds to existing processes for courts to review
requests, among other concerns.
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GOVERNOR'S VETO MESSAGE:
I am returning Senate Bill 253 without my signature.
This bill adds more requirements for juvenile court
authorization and oversight of psychotropic medications for
children in the child welfare and probation systems.
Last year, I signed a bill that required the Judicial
Council, working with stakeholders, to amend and adopt rules
of court and forms to help judges determine whether to
authorize the use of psychotropic medications. These new
rules and forms took effect July 1, 2016, and require
significantly more information to be submitted to the court.
Until we know the impact of these changes, it is premature to
legislate additional measures.
ASSEMBLY FLOOR: 75-0, 8/18/16
AYES: Achadjian, Alejo, Travis Allen, Arambula, Atkins, Baker,
Bloom, Bonilla, Bonta, Brough, Brown, Burke, Calderon, Campos,
Chang, Chau, Chávez, Chiu, Chu, Cooley, Cooper, Dababneh,
Dahle, Daly, Dodd, Eggman, Frazier, Beth Gaines, Gallagher,
Cristina Garcia, Eduardo Garcia, Gatto, Gipson, Gomez,
Gonzalez, Gray, Grove, Hadley, Harper, Holden, Irwin, Jones,
Jones-Sawyer, Kim, Lackey, Levine, Linder, Lopez, Low,
Maienschein, Mathis, Mayes, McCarty, Medina, Melendez, Mullin,
Nazarian, Obernolte, O'Donnell, Olsen, Quirk, Ridley-Thomas,
Rodriguez, Salas, Santiago, Steinorth, Mark Stone, Thurmond,
Ting, Wagner, Waldron, Weber, Wilk, Wood, Rendon
NO VOTE RECORDED: Bigelow, Gordon, Roger Hernández, Patterson,
Williams
Prepared by:Mareva Brown / HUMAN S. / (916) 651-1524
10/18/16 12:15:32
**** END ****
SB 253
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