BILL ANALYSIS Ó SB 938 Page 1 Date of Hearing: August 3, 2016 ASSEMBLY COMMITTEE ON APPROPRIATIONS Lorena Gonzalez, Chair SB 938 (Jackson) - As Amended June 29, 2016 ----------------------------------------------------------------- |Policy |Judiciary |Vote:|10 - 0 | |Committee: | | | | | | | | | | | | | | |-------------+-------------------------------+-----+-------------| | | | | | | | | | | | | | | | |-------------+-------------------------------+-----+-------------| | | | | | | | | | | | | | | | ----------------------------------------------------------------- Urgency: No State Mandated Local Program: NoReimbursable: No SUMMARY: This bill requires additional oversight before psychotropic medication can be prescribed to a conservatee with a major neurocognitive disorder (MNCD), generally dementia. Specifically, this bill: 1)Clarifies a conservator's authority to place a conservatee SB 938 Page 2 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. 2)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 contain additional information, as specified. 3)Provides 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. 4)Provides that, if a court has granted a conservator the power to administer psychotropic medication, the court must review the authority when periodically reviewing the conservatorship as required by law. 5)Requires, on or before July 1, 2017, the Judicial Council to adopt rules of court and develop appropriate forms for the SB 938 Page 3 implementation of this bill. 6)Provides that the requirements of this bill 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. FISCAL EFFECT: 1)Minor one-time costs to the Judicial Council for additional workload likely in the range of $50,000 to $70,000 (GF) to adopt rules of court, develop appropriate forms, and provide the specified guidance on how to evaluate requests for authorization. 2)Unknown potential increase in court workload (GF) 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 NCDs. COMMENTS: 1)Purpose. This bill, sponsored by California Advocates for Nursing Home Reform (CANHR), seeks to update 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, 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 SB 938 Page 4 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. 2)Background. 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 protections. 3)Prior Legislation. SB 238 (Mitchell and Beall), Chapter 534, Statutes of 2015, among its provisions, revised and enhanced the existing requirements for court authorization for the administration of psychotropic medication to minor placed in foster care. Analysis Prepared by:Jennifer Swenson / APPR. / (916) 319-2081 SB 938 Page 5