BILL ANALYSIS Ó
SB 938
Page 1
Date of Hearing: June 28, 2016
ASSEMBLY COMMITTEE ON JUDICIARY
Mark Stone, Chair
SB
938 (Jackson) - As Amended May 31, 2016
As Proposed to be Amended
SENATE VOTE: 39-0
SUBJECT: Conservatorships: psychotropic medications
KEY ISSUE: IN ORDER TO BETTER PROTECT VULNERABLE CONSERVATEES
FROM INAPPROPRIATELY BEING PRESCRIBED POTENT PSYCHOTROPIC DRUGS
WITH POTENTIALLY SIGNIFICANT AND EVEN DEADLY HEALTH
CONSEQUENCES, SHOULD THE LIMITED COURT OVERSIGHT of prescribing
practices today BE IMPROVED?
SYNOPSIS
If a person is unable to adequately provide for his or her
personal needs or incapable of managing his or her assets, a
probate court can establish a conservatorship. Because of
concerns of mistreatment and misuse of potent psychotropic
medication, the Legislature created special judicial oversight
to protect conservatees with dementia from being unnecessarily
overmedicated. Psychotropic medications, including
antipsychotics, antidepressants and psychostimulants, alter
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chemical levels in the brain which impact mood and behavior. SB
1481 (Mello), Chapter 910, Statutes of 1996, established
protections to provide, within the scheme of a probate
conservatorship, the authority to place a person with dementia
in a secure perimeter facility and to authorize the
administration of dementia medications. This bill, sponsored by
California Advocates for Nursing Home Reform, seeks to update
those 20-year old rules and provide better guidance to courts
when determining whether to authorize a conservator to give
psychotropic medication to a conservatee with dementia. To
provide better guidance on whether psychotropic medication
should be administered to dementia conservatees, the bill
requires additional information to be provided in a physician
declaration filed in support of the conservator's petition to
authorize the administration of psychotropic medication, and
requires Judicial Council to update rules and forms to better
assist with the reporting. The bill also revises existing law
to reflect the various dementia disorders that fall under the
new, broader diagnostic category of major neurocognitive
disorders and make various conforming changes.
This bill is supported by groups and individuals, including the
Judicial Council, the Trusts & Estates Section of the State Bar,
Disability Rights California, and the California Long-Term Care
Ombudsman Association, who argue that the clarifications and
updates provided by this bill will better protect vulnerable
elderly individuals with dementia from being improperly
prescribed strong psychotropic medication without proper court
oversight. The bill, as in print, is opposed by a coalition of
hospitals, health facilities and assisted living facilities, as
well the Alzheimer's Association and the Public Guardian, who
are concerned that the additional requirements in the bill could
result in harm to the very individuals the bill is trying to
protect by making it more difficult for them to get the
medication they need and will increase costs for courts,
families and conservatees. The author has agreed to amend the
bill to, among other things, specifically provide that if a
court has granted a conservator the power to administer
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psychotropic medication to a conservatee, the conservator may,
consistent with the authority granted by the court, change or
adjust the psychotropic medications without further notice or
approval by the court, as provided. This should significantly
reduce concerns about having to go back to court for each dose
or medication change, thus easing concerns about timely access
to medication, clogged courts and higher costs for conservatees.
It is unclear if these amendments change opponents' position on
the bill.
SUMMARY: Requires additional oversight before psychotropic
medication can be prescribed to a conservatee with a major
neurocognitive disorder (MNCD, generally dementia).
Specifically, this bill:
1)Defines MNCDs as defined in the latest edition of the
diagnostic and Statistics Manual of Mental Disorders.
Legislative findings define MNCDs to include Alzheimer's
disease, vascular dementia, dementia with Lewy bodies, and
Parkinson dementia.
2)Defines psychotropic medication, for purposes of this bill, as
including, but not limited to, anxiolytic agents,
antidepressants, mood stabilizers, antipsychotic medications,
hypnotics and psychostimulants. "Psychotropic medications"
does not include medications approved by the Food and Drug
Administration for the treatment of MNCDs or anti-Parkinson
agents.
3)Clarifies a conservator's authority to place a conservatee
with a MNCD in a secured perimeter residential facility for
the elderly (as opposed to a locked facility), provided it is
the least restrictive placement appropriate for the
conservatee's needs. Deletes the prohibition against
placement of a conservatee in a mental health rehabilitation
center or institution for mental disease, as specified.
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4)Requires that before a conservator can authorize the
administration of psychotropic medication to a conservatee, a
court must make certain specified findings, already in
existing law, by clear and convincing evidence. Requires that
the physician's supporting declaration, required for the
conservator's petition requesting authority to administer
psychotropic medication in existing law, must additionally
contain:
a) A description of the conservatee's diagnosis and
behavior;
b) The recommended course of medication;
c) A description of the treatments and medications that
have been used or proposed, less invasive treatments or
medications used or proposed, and why these treatments or
medications have not or would not be effective in treating
the conservatee;
d) The expected effects of the proposed medication on the
conservatee's health and treatment plan, including how the
medication is expected to improve the conservatee's
symptoms;
e) The potential side effects of the proposed medication,
include any black box warnings; and
f) Whether the conservatee and his or her attorney have had
an opportunity to provide input on the proposed
medications.
5)Provides that, if a court has granted a conservator the power
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to administer psychotropic medication to a conservatee, the
conservator may, consistent with the authority granted by the
court, change or adjust the psychotropic medications without
further notice or approval by the court, provided the
conservator has received information about the risks, benefits
and alternatives before making the change.
6)Provides that, if a court has granted a conservator the power
to administer psychotropic medication to a conservatee, the
court shall review the authority when periodically reviewing
the conservatorship as required by law.
7)Requires, on or before July 1, 2017, the Judicial Council to
adopt rules of court and develop appropriate forms for the
implementation of this bill, and to 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.
8)Provides that the requirements of this legislation do not
apply to conservatees who are prescribed psychotropic
medication by a physician in an acute care hospital or for
purposes of diagnostic or therapeutic treatment not directly
related to the MNCD, including, but not limited to, sedation
prior to an invasive procedure or nausea prevention or relief,
and instead, the conservator may make medical decisions if the
conservatee lacks capacity, as provided.
9)Revises legislative findings and declarations regarding MNCDs.
EXISTING LAW:
1)Allows the court to appoint a conservator to act on behalf of
a person who is unable to adequately provide for his or her
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personal needs (a conservator of the person) or incapable of
managing his or her property or other financial assets (a
conservator of the estate). (Probate Code Section 1800 et
seq. Unless stated otherwise, all further statutory
references are to that code.)
2)Specifies the powers and duties of a conservator and the
powers and rights retained by a conservatee subject to a
conservatorship. (Section 2350 et seq.)
3)Authorizes the conservator to establish the residence of the
conservatee at any place within California without the
permission of the court and requires the conservator to select
the least restrictive appropriate residence. (Section 2352
(b).)
4)Provides that if the conservatee has not been adjudicated to
lack the capacity to give informed consent for medical
treatment, the conservatee may consent to his or her medical
treatment; the conservator may also give consent to the
medical treatment, but the consent of the conservator is not
required if the conservatee has the capacity to give informed
consent to the medical treatment, and the consent of the
conservator alone is not sufficient if the conservatee objects
to the medical treatment. After obtaining a court order
specifically authorizing medical treatment, authorizes the
conservator to require the conservatee to receive medical
treatment, whether or not the conservatee consents to the
treatment. (Section 2354.)
5)If the conservatee has been adjudicated to lack the capacity
to make health care decisions, provides the conservator the
exclusive authority to make health care decisions for the
conservatee that the conservator in good faith, based on
medical advice, determines to be necessary. (Section 2355.)
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6)If a conservatee is unable to give an informed consent to
medical treatment for an existing or continuing medical
condition which is not authorized to be performed, authorizes
the conservator to petition the court for an order authorizing
the medical treatment and authorizing the conservator to
consent on behalf of the conservatee, as provided. (Section
2357.)
7)Makes legislative findings that, among other things the
administration of psychotropic medications has been, and can
be, abused by caregivers and, therefore, granting powers to a
conservator to authorize these medications for the treatment
of dementia requires protections. (Section 2356.5 (a).)
8)Allows a conservator to place a conservatee in a secured
perimeter residential care facility for the elderly, upon a
court making specified findings, by clear and convincing
evidence, as provided. (Section 2356.5 (b).)
9)Allows a conservator to authorize the administration of
medications appropriate for the care and treatment of
dementia, upon a court making specified findings, by clear and
convincing evidence, as provided. (Section 2356.5 (c).)
10)Prohibits placement of a conservatee in a mental health
rehabilitation center or in an institution for mental disease,
as specified. (Section 2356.5 (e).)
11)Requires the conservatee, at a hearing to either place the
conservatee in a secured perimeter residential care facility
or allow for the administration of medication appropriate for
the care and treatment of dementia, to be represented by an
attorney, as specified. (Section 2356.5 (f).)
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12)Requires the court investigator annually to investigate and
report to the court every two years, as specified, if the
conservator is authorized to place the conservatee in a
secured perimeter residential care facility or administer
medication appropriate for the care and treatment of dementia,
and the investigator is required to specifically advise the
conservatee that he or she has the right to object to the
conservator's powers, and the report is required to include
whether the powers granted are warranted. (Section 2356.5
(g).)
FISCAL EFFECT: As currently in print this bill is keyed fiscal.
COMMENTS: If a person is unable to adequately provide for his
or her personal needs or incapable of managing his or her
assets, a probate court can establish a conservatorship.
Because of concerns of mistreatment and misuse of potent
psychotropic medication on those with dementia, the Legislature
created special judicial oversight to protect conservatees with
dementia from being unnecessarily overmedicated. Psychotropic
medications, including antipsychotics, antidepressants and
psychostimulants, alter chemical levels in the brain which
impact mood and behavior. SB 1481 (Mello), Chapter 910,
Statutes of 1996, established protections to provide, within the
scheme of a probate conservatorship, the authority to place a
person with dementia in a secure facility and to authorize the
administration of dementia medications. This bill seeks to
update those 20-year old rules and provide better guidance to
courts when determining whether to authorize a conservator to
give psychotropic medication to a conservatee with dementia. To
provide better guidance on whether psychotropic medication
should be administered to dementia conservatees, the bill
requires additional information to be provided in a physician
declaration filed in support of the conservator's petition to
authorize the administration of psychotropic medication, and
requires Judicial Council to update rules and forms to better
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assist with the reporting. The bill also revises existing law
to reflect the various dementia disorders that fall under the
new, broader diagnostic category of MNCDs and make various
conforming changes.
In support of the bill, the sponsor, California Advocates for
Nursing Home Reform (CANHR), writes:
The purpose of enacting [SB 1481] was to address the
involuntary administration of medication (and locked door
residential placement) for people with dementia by
establishing a protective review and authorization process
within the context of a conservatorship. At the time,
psychotropic drugs were known to be used inappropriately,
particularly in institutional residential settings like
nursing homes, but stood as the primary "treatment" option for
people with dementia who presented behavioral challenges.
Since the law was created, studies have shown that
psychotropic drugs are a particularly poor treatment option
for people with dementia. They often exacerbate rather than
ameliorate symptoms, have disabling side effects, and in some
cases substantially increase mortality rates. Most notably,
psychotropic drugs for people with dementia do not resolve an
underlying mental health condition; instead, they mask the
real problems such as distress, pain, or discomfort that have
been expressed through behaviors. In short, psychotropic
drugs for people with dementia typically cause more problems
than they solve.
The Judicial Council writes of its support for this bill, which
"seeks to strengthen the law governing the use of psychotropic
medications for persons subject to dementia conservatorships.
The council recognizes that conservatees with dementia are very
vulnerable individuals and we are mindful of the important role
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that probate courts perform in helping to ensure their proper
care and treatment. Providing more complete information
regarding the proposed use of psychotropic medications for these
conservatees should help avoid abuse, thereby improving the
court's oversight and administration of these important cases."
Adds the National Association of Social Workers, California
Chapter: "It has been shown that psychotropic drugs can be very
dangerous for elderly patients with dementia. Unfortunately,
these drugs are widely used and it has alerted advocates to the
need for reform. . . . This bill will help to protect seniors
from being wrongly or over[-]medicated."
Types of Conservatorships: A probate judge may appoint a
conservator to act on behalf of a person who is unable to
adequately provide for his or her personal needs (a "conservator
of the person") or incapable of managing his or her property or
other financial assets (a "conservator of the estate").
(Section 1800 et seq.) The Probate Code also offers a "limited
conservatorship" for "developmentally disabled adults," under
which the court limits the conservator's power so as to preserve
the maximum amount of independence and self-sufficiency for the
conservatee. (Section 1801 (d).) In addition, the
Lanterman-Petris-Short (LPS) Act created a special adult
conservatorship for persons who were considered "gravely
disabled" by reason of mental illness or chronic alcoholism and
subject to confinement in a locked psychiatric facility and
administration of psychotropic medication, subject to more
extensive oversight than a probate conservatorship. (Welfare &
Institutions Code Section 5330 et seq.)
Conservatorship with Special Dementia Powers: In 1996, the
Legislature created an alternative to the LPS conservatorship
for people with dementia. AB 1481 (Mellow), 1996, allows a
conservator under a Probate Code conservatorship to seek special
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powers to confine a conservatee with dementia in a "secured
perimeter" residential care facility and to administer
medication for dementia if various conditions, designed to
protect the conservatee, are met. These conditions include the
appointment of an attorney to represent the conservatee during
the court's consideration of the conservator's petition for the
dementia powers. While the legislative intent language to the
statute discusses psychotropic medication and notes that these
drugs have been, and can be, "abused by caregivers and,
therefore, granting powers to a conservator to authorize these
medications for the treatment of dementia requires the
protections specified in this section" (Section 2356.5 (a)(3)),
the statutory mandate for court oversight uses the term
"medications appropriate for the care and treatment of
dementia."
There are significant risks to treating dementia patients with
certain psychotropic medication. Beginning in 2005 and expanded
in 2008, the United States Food and Drug Administration (FDA)
required all antipsychotic medications, which are a class of
psychotropic drugs, to include a "black box" warning that these
medications significantly increase the risk of death in elderly
people with dementia. A typical black box warning looks like
this:
The FDA website warns health care professionals against
prescribing antipsychotics to patients with dementia:
" Elderly patients with dementia-related psychosis treated
with conventional or atypical antipsychotic drugs are at an
increased risk of death.
" Antipsychotic drugs are not approved for the treatment
of dementia-related psychosis. Furthermore, there is no
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approved drug for the treatment of dementia-related
psychosis. Healthcare professionals should consider other
management options.
" Physicians who prescribe antipsychotics to elderly
patients with dementia-related psychosis should discuss
this risk of increased mortality with their patients,
patients' families, and caregivers. (FDA, Information for
Healthcare Professionals: Conventional Antipsychotics
(http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInf
ormationforPatientsandProviders/ucm124830.htm).)
Following the national movement to reduce the administration of
antipsychotic medications to dementia patients, the Centers for
Medicare & Medicaid Services Region IX and the California
Department of Public Health, together with a diverse group of
stakeholders, formed a partnership to develop a collaborative
action plan for improving dementia care and reducing the
inappropriate use of antipsychotic medication in California
Nursing Homes. (Centers for Medicare & Medicaid Services,
Region IX, Cal. Dept. of Public Health, Working Together:
California Partnership to Improve Dementia Care and Reduce
Unnecessary Antipsychotic Medication Drug Use in Nursing Homes,
Summary Report (Dec. 2012).) Yet, a 2014 report released by the
United States Government Accountability Office on the use of
antipsychotic drugs in nursing homes noted that prescribing
rates of antipsychotic drugs to nursing home residents with
dementia continues to be too high, especially when the FDA has
not approved the use of antipsychotic drugs to treat the
behavioral symptoms of dementia. (U.S. Government
Accountability Office, Report to Congressional Requesters,
Antipsychotic Drug Use: HHS Has Initiatives to Reduce Use among
Older Adults in Nursing Homes, but Should Expand Efforts to
Other Settings (GAO-15-211) (Jan. 2015) pp. 1-2.) According to
that report, experts and research attribute the high incidence
of antipsychotic use on dementia patients to the culture of the
nursing facility, the level of physician and staff training and
education, and the number of staff at the nursing home. (Id.,
p. 23.) Further, the report noted that it is estimated that
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close to one in five older adults with dementia living outside
of a nursing home took an antipsychotic between 2002 and 2004.
(Id., p. 3.)
According to the sponsor, other types of psychotropic
medication, beyond antipsychotics, also pose significant risk
for those with dementia: "Antianxiety and hypnotic drugs have
proven quite dangerous for elderly people with dementia and
often exacerbate, rather than alleviate, anxiety and dementia."
(Footnote omitted.) CANHR states that even antidepressants have
risks of harm to people with dementia. And, even assuming the
risks are reasonable, CAHNR finds that the benefits of these
drugs on those with dementia are minimal:
The benefits -- if they can be called benefits -- in using
psychotropic drugs for people with dementia are sedation
and submission. The drugs increase fatigue and decrease
activity, thereby rendering a patient more "manageable"
while often incapacitating them. The subsequent incapacity
and decline in physical activity increases the patient's
suseptibility to devastating falls, pressure sores, weight,
and infection. These results are the main reason why
psychotropic drugs lead to such negative clinical outcomes
for elderly people with dementia.
This bill is similar to legislation last year that protected
foster children from overmedication with psychotropic
medication. In response to growing concerns that psychotropic
medications have been relied on by California's child welfare
and children's mental health systems as a means of controlling,
instead of treating, youth who suffer from trauma-related
behavioral health challenges, the Legislature last year passed a
package of bills designed to reduce the use of psychotropic
medication in this most vulnerable population. One bill in that
package, SB 238 (Mitchell and Beall), Chapter 534, Statutes of
2015, provides, very similarly to this bill, protections and
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oversight over psychotropic medication by requiring the Judicial
Council to update forms and rules to ensure improved and
regularly updated information is solicited from, and received
by, appropriate individuals and entities regarding use of
psychotropic medication. While conservatees with dementia are
very different from foster children suffering trauma, both are
extremely vulnerable and under the watchful oversight of the
court.
Additional physician declaration requirements. Existing law
requires a conservator's petition for authorization to place a
conservatee with dementia in a secure residential care facility
for the elderly or to authorize the administration of
medications for dementia to be supported by a physician's or
psychologist's declaration. In order to obtain authorization
for the administration of psychotropic medications, the
mandatory Judicial Council Form GC-335A, Dementia Attachment to
Capacity Declaration - Conservatorship, requires the
conservatee's physician or psychologist to list the psychotropic
medications to be administered, describe the conservatee's
mental function deficits, determine whether the conservatee has
capacity to give informed consent to the administration of
psychotropic medications appropriate to the care of dementia,
and state the reasons the conservatee needs, or would benefit
from, the administration of the psychotropic medications.
This bill first requires that a declaration on medication can
only be provided by a physician (this corrects an ambiguity in
current law and is necessary for scope of practice issues, since
psychologists cannot prescribe medication). This bill then
expands the information to be provided by the physician to
include:
A description of the conservatee's diagnosis and behavior;
The recommended course of medication;
A description of the pharmacological and nonpharmacological
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treatments and medications that have been previously used or
proposed, the less invasive treatments or medications
previously used or proposed, and why these treatments and
medications have not been or would not be effective in
treating the conservatee's symptoms;
The expected results of the recommended medication on the
conservatee's overall mental health and treatment plan,
including how the medication is expected to improve the
conservatee's symptoms;
A description of the potential side effects of the recommended
medication; and
Whether the conservatee and his or her attorney have had an
opportunity to provide input on the recommended medications.
In accordance with the original intent of existing law to
protect conservatees with dementia from overmedication by
caregivers, the author argues that these new reporting
requirements, better defines the criteria upon which a court
would determine whether a conservator should have the ability to
authorize the administration of psychotropic medications to a
conservatee with dementia.
In addition to that list, the bill also requires the Judicial
Council to 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. Revised forms
should help simplify the process and reduce workload for both
physicians and the court.
Placement of conservatees with dementia in facilities. This
bill strikes from existing law the prohibition on placing a
conservatee with an MNCD in a mental health rehabilitation
center or institution for mental disease, as specified. It
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appears that when the original law was drafted in 1996, this
prohibition was included to make certain that conservatees with
dementia were not placed in a facility that may not provide
appropriate dementia care, as opposed to care appropriate for
treating other mental disorders. However, existing law and this
bill only authorize placement of the conservatee with dementia
in a secured perimeter residential care facility for the elderly
(RCFE). Additionally, subject to the provisions of a valid and
effective advance health care directive, existing law otherwise
prohibits placing a conservatee, regardless of whether the
conservatee has been diagnosed with dementia, in a mental health
treatment facility against his or her will, and involuntary
civil placement of a conservatee in a mental health treatment
facility may only be obtained pursuant to the
Lanterman-Petris-Short Act, as specified. Further, the removal
of the prohibition on placing a conservatee with dementia in a
mental health rehabilitation center or institution for mental
disease is arguably inconsequential since existing law, and this
bill, only authorize placement of conservatees with dementia in
RCFEs, which are not licensed as mental health or psychiatric
facilities.
This bill also cleans-up the incorrect statutory reference to
"locked facility," and instead refers to the placement of
dementia patients in "secured perimeter" facilities, as opposed
to locked facilities.
Opposition to bill in print concerned that it could jeopardize
patient access to appropriate medical care, clog courts and
result in higher costs. The California Assisted Living
Association, the California Association of Health Facilities,
the California Council of the Alzheimer's Association, the
California Hospital Association, the California Psychiatric
Association and LeadingAge California jointly oppose the bill in
print because they are concerned that the bill, while
well-intentioned, will "jeopardize patients' access to timely
and appropriate medical care, clog the court system, and result
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in higher medical and legal costs for these patients and their
families." The opponents add:
SB 938 (Jackson) places a huge new burden on patients with a
MNCD who have a conservator, their families, their physicians
and nurses, and the court system. This bill would require
such patients to go to court for judicial approval each time a
physician orders a new or different antidepressant, sleeping
pill, anti-anxiety medication, antipsychotic, or other
psychotherapeutic drug. The patient's medical treatment would
be delayed for the time needed to prepare the extensive
paperwork for the judge that is required by this bill, get on
the judge's calendar, and obtain a judicial decision.
Consider the situation where a woman with Alzheimer's disease
learns that her husband has passed away, and she is so
distraught she cannot sleep. Her physician could not order a
sleeping pill or anti-anxiety medication - even with the
conservator's approval - without going to court first. This
is simply bad patient care.
The State Association of Public Administrators, Public Guardian,
and Public Conservators concurs with the other opponents and
believes that this bill will make it more difficult for the
government's conservators of last resort to do their job and
could result in people who legitimately need psychotropic
medication being "denied proper treatment."
In response to these concerns, the author has agreed to amend
the bill to specifically provide that if a court has granted a
conservator the power to administer psychotropic medication to a
conservatee, the conservator may, consistent with the authority
granted by the court, change or adjust the psychotropic
medications without further notice or approval by the court,
provided the conservator has received information about the
risks, benefits and alternatives before making the change. This
should significantly reduce concerns about having to go back to
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court for each dose or medication change, thus easing issues
about timely access to medication, clogged courts and higher
costs for conservatees.
The author's amendments also address concerns raised by
hospitals of the need to prescribe drugs both in emergency and
nonemergency settings by specifically exempting psychotropic
medication given in an acute care hospital and for purposes of
diagnostic or therapeutic treatment not directly relates to a
MNCD, such as sedation prior to an invasive treatment or nausea
relief. The amendments also clean-up a scope of practice
problems with existing law that seemed to imply that
psychologists could prescribe psychotropic medication, and
clarifies that courts, in their annual or bi-annual review of
conservatorships, should review the powers given to conservators
to place a conservatee with dementia in a secure perimeter
facility or authorize the administration of psychotropic
medication.
What the amendments do not do is limit the bill's application to
just antipsychotic drugs that come with the FDA's black box,
risk of death, warning. The opponents argue that antipsychotic
drugs are the riskiest drugs for those with dementia and thus
increased court oversight may be warranted for them, but not
necessarily for the broader list of psychotropic drugs. The
sponsor counters that existing law already applies to all
psychotropic medication and that limiting this bill to just
antipsychotic drugs would actually reduce the protections
provided by existing law. While existing law contains
legislative intent on the dangers of psychotropic medication,
the actual language used in the regulating provision is
"medications appropriate for the care and treatment of
dementia." The Judicial Council, in its required court form
(GC-335), combines both language and requires conservators today
to seek court approval for administration of "psychotropic
medications appropriate to the care of dementia." Moreover, the
Trusts & Estates Section of the Bar, a supporter, confirms its
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understanding that psychotropic medication is already included
in existing law and this bill simply clarifies that fact and
"provides a mechanism for the court to ensure that an
'evaluation of the risks,' a considerations of the 'reasonable
alternative treatment and risks, and why the health professional
is recommending the particular treatment' have in fact been
considered by the conservator prior to the grant of authority to
authorize the use of such psychotropic medications." Thus, this
bill helps clears up any possible ambiguity in existing law,
consistent with legislative intent, and provides clear direction
of the need to have court oversight of psychotropic medication
for this very vulnerable population.
It is unclear if these latest amendments change the opponents'
position on the bill, but they do go a long way to addressing
the issues set forth in their letters of opposition.
REGISTERED SUPPORT / OPPOSITION:
Support
California Advocates for Nursing Home Reform (sponsor)
California Long-Term Care Ombudsman Association
Consumer Attorneys of California
Disability Rights California
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Judicial Council of California
National Association of Social Workers - California Chapter
Trusts and Estates Section of the State Bar of California
Some individuals
Opposition (to the bill in print)
California Assisted Living Association
California Association of Health Facilities
California Council of the Alzheimer's Association
California Hospital Association
California Psychiatric Association
LeadingAge California
State Association of Public Administrators, Public Guardian, and
Public Conservators
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Analysis Prepared by:Leora Gershenzon / JUD. / (916) 319-2334