BILL ANALYSIS                                                                                                                                                                                                    Ó



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          Date of Hearing:  August 3, 2016


                        ASSEMBLY COMMITTEE ON APPROPRIATIONS


                               Lorena Gonzalez, Chair


          SB 938  
          (Jackson) - As Amended June 29, 2016


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          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  








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            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  








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            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  








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            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









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