BILL ANALYSIS Ó
SENATE COMMITTEE ON APPROPRIATIONS
Senator Ricardo Lara, Chair
2015 - 2016 Regular Session
SB 938 (Jackson) - Conservatorships: psychotropic drugs
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|Version: March 15, 2016 |Policy Vote: JUD. 7 - 0 |
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|Urgency: No |Mandate: No |
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|Hearing Date: April 11, 2016 |Consultant: Jolie Onodera |
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This bill meets the criteria for referral to the Suspense File.
Bill
Summary: SB 938 would increase judicial oversight under
existing provisions of law with regard to the authority of
probate conservators over conservatees with dementia, as
follows:
Requires additional information to be included in the
physician or psychologist declaration filed in support of a
conservator's petition to authorize the administration of
psychotropic medication to a conservatee with dementia.
Requires the Judicial Council to adopt rules of court and
develop appropriate forms by July 1, 2017, and provide
guidance to the courts on how to evaluate a request to
authorize the administration of psychotropic medication to
these conservatees.
Replaces references to the term "dementia" with "major or mild
neurocognitive disorders (MNCDs)," as defined in the last
published edition of the Diagnostic and Statistical Manual of
Mental Disorders (DSM-5).
Expands the population of conservatees for whom a conservator
must petition the court for authority to place in a secured
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perimeter residential care facility for the elderly (RCFE) or
to administer psychotropic medications to include not only
those with dementia (major NCDs) but also those with cognitive
impairments not severe enough to qualify for a diagnosis of
dementia (mild NCDs).
Fiscal
Impact:
One-time costs to the Judicial Council for additional workload
potentially in excess of $50,000 (General Fund*) to adopt
rules of court, develop appropriate forms, and provide the
specified guidance on how to evaluate requests for
authorization.
Potentially significant increase in court workload (General
Fund*) for additional petitions to the court requesting
authorization for the administration of medications under the
category of "psychotropic medications" for the expanded
population of conservatees with major or mild NCDs.
*Trial Court Trust Fund
Background: Existing law requires a conservator to petition the court for
authorization to place a conservatee with dementia in a secured
perimeter residential care facility for the elderly (RCFE) or to
authorize the administration of medications appropriate for the
care and treatment of conservatees with dementia. (Probate Code
§ 2356.5.)
For authorization to administer medications appropriate for the
care and treatment of dementia, the Judicial Council Form
GC-335A, Dementia Attachment to Capacity
Declaration-Conservatorship, requires the conservatee's
physician or psychologist to include specified information
including a list of the medications to be administered, a
description of the conservatee's mental function deficits,
whether the conservatee has the capacity to give informed
consent to the administration of psychotropic medications, and
the reasons the conservatee needs or would benefit from the
administration of the psychotropic medications.
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This bill seeks to require additional information to be provided
to the court for its determination of whether a petition to
authorize a conservator to have psychotropic medications
administered to a conservatee is justified.
Under existing law, the enhanced due process protections
described above are provided for conservatees with "dementia,"
as defined in the last published edition of the Diagnostic and
Statistical Manual of Mental Disorders. The newest edition of
the manual is Volume 5, commonly referred to as "DSM-5," which
introduced several changes in the diagnostic criteria for
dementia. Under DSM-5, cognitive disorders not causing
sufficient impairment to qualify for a diagnosis of dementia
were redefined as mild neurocognitive disorders (NCDs) and
placed on the spectrum with the more severe conditions of
dementia which constitute nearly all of the major NCDs.
This bill seeks to replace the term "dementia" with the term
"major or mild neurocognitive disorders (MNCDs)," thereby
extending the existing due process protections over facility
placement and psychotropic medication administration to a larger
population of conservatees.
Proposed
Law: This bill would increase judicial oversight under existing
provisions of law with regard to the authority provided to
probate conservators over conservatees with dementia, as
follows:
Increases the amount of information required in the
physician's or psychologist's declaration filed in support of
a petition requesting authority of the conservator to
authorize the administration of psychotropic medications to a
conservatee to include information including but not limited
to a description of the conservatee's diagnosis and behavior,
the recommended course of medication, the expected effects of
the recommended medication on the conservatee's overall mental
health and treatment plan, a description of the potential side
effects of the recommended medication, and whether the
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conservatee and his or her attorney have had an opportunity to
provide input on the recommended medications.
Revises and adds to existing codified legislative findings and
declarations regarding probate conservatorships of persons
with dementia, as follows:
o Replaces the term "dementia" with "major or mild
neurocognitive disorders (MNCDs)," and lists common forms
of MNCDs as Alzheimer's disease, vascular dementia,
dementia with Lewy bodies, Parkinson dementia,
frontotemporal dementia, and mixed dementia.
o Adds legislative declarations regarding psychotropic
medications, including but not limited to, that
"psychotropic medications or psychotropic drugs are those
medications administered for the purpose of affecting the
central nervous system to treat psychiatric disorders or
illnesses," and additionally, "psychotropic medications are
often misused for people with MNCDs to control behavior
that conveys pain, distress, or discomfort, and the
administration of psychotropic medications has been, and
can be, abused by those who prescribe and administer these
medications."
Requires the Judicial Council to, on or before July 1, 2017,
adopt rules of court and develop appropriate forms for the
implementation of the bill, and provide guidance to the court
on how to evaluate the request for authorization, including
how to proceed if information, otherwise required to be
included in a request for authorization, is not included in a
request for authorization submitted to the court.
Replaces the term "dementia" as referred to throughout Probate
Code § 2356.5 with the term "MNCDs," consistent with the
revision to the codified legislative findings and
declarations.
Prior
Legislation: SB 238 (Mitchell) Chapter 534/2015, among its
provisions, revised and enhanced the existing requirements for
court authorization for the administration of psychotropic
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medication to minors placed in foster care.
Staff
Comments: This bill requires the Judicial Council to adopt
rules of court, develop appropriate forms, and provide guidance
to the courts on how to evaluate a request to authorize the
administration of psychotropic medication to conservatees with
MNCDs. As a result, it is estimated the Judicial Council would
incur one-time costs potentially in excess of $50,000 (General
Fund) for the additional workload created by the mandates in
this measure.
By expanding the population of conservatees for which a
conservator must petition the court for authorization to place
in a secured perimeter RCFE or to administer psychotropic
medications, the provisions of this bill could result in an
increase in the number of petitions to the court. While the
magnitude of the court workload increase cannot be estimated
with certainty, as the category of psychotropic medications
includes numerous medications, and it is unclear whether
multiple petitions to the court would be required under the new
requirement to provide the course of recommended medications
when dosages or medication changes occur, the increase in court
workload could potentially be significant.
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