BILL ANALYSIS
AB 82
Page 1
Date of Hearing: March 31, 2009
ASSEMBLY COMMITTEE ON JUDICIARY
Mike Feuer, Chair
AB 82 (Evans) - As Introduced: December 23, 2008
SUBJECT : Dependent children: PSYCHOTROPIC MEDICATIONS
KEY ISSUE : IN ORDER TO PROTECT YOUTH IN FOSTER CARE, SHOULD
THERE BE BETTER OVERSIGHT OF THE ADMINISTRATION OF PSYCHOTROPIC
MEDICATIONS TO THEM?
FISCAL EFFECT : As currently in print this bill is keyed fiscal.
SYNOPSIS
This bill seeks to ensure better oversight of the use of
psychotropic medications for youth in foster care. It is a
repeat of last year's AB 2117 (Evans), which passed out of this
Committee on a 10-0 vote, but was held in the Senate
Appropriations Committee. According to the author, many
children and youth in foster care and youth probation systems
have unmet needs for mental health care. For some of these
youth, psychotropic medications are a key component of effective
treatment for conditions that affect their safety, emotional
well-being, and ability to succeed in school and other settings.
In recent years, however, mental health professionals,
children's advocates, and former foster youth in California and
nationally have expressed concerns about the potential over- or
under- use of psychotropic medications for children in the
foster care and probation systems. In testimony provided before
the Blue Ribbon Commission on Foster Care and the Select
Committee on Foster Care, some foster youth told of being put on
medications when they were very young - as young as 4 or 5 years
old - and remaining on different medications their entire
childhoods. Others described being prescribed multiple
medications, or having their medications changed frequently and
abruptly each time they were moved to a new placement or new
mental health care provider.
This bill contains various helpful provisions to improve
oversight of the use of psychotropic medications for youth in
foster care and probation systems. This bill is sponsored by
the Children's Law Center of Los Angeles and supported by groups
including California Youth Connection, the Family Law Section of
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the State Bar and the Youth Law Center. It passed out of
Assembly Human Services on a 7-0 vote. There is no known
opposition.
SUMMARY : Changes the requirements that must be met before and
after a juvenile court judicial officer may authorize the
administration of psychotropic medications to children in foster
care. Specifically, this bill :
1)Authorizes juvenile court judicial officers to make orders
regarding the administration of psychotropic medications to a
child who has been removed from the physical custody of a
parent or guardian, pending adjudication as a dependent child.
2)Requires physicians or other health professionals requesting
authorization to administer psychotropic medications to a
dependent child, a child awaiting adjudication as a dependent
child, or a ward of the court in foster care to have conducted
an examination and to include information on the child's
medical history, the probability of side effects of the
medication, and a description of recommended therapy in the
request.
3)Requires the juvenile court judicial officer, before
authorizing the administration of psychotropic medication, to
make findings that:
a) The child's caregiver has been informed, and the child
has been informed in an age and developmentally appropriate
manner, about the recommended medications, anticipated
benefits, possible side effects and any other recommended
treatment;
b) The child has been informed of his or her right to
request a hearing on the issue; and
c) A plan is in place for the physician to monitor the
medication, in consultation with the child's caregiver,
mental health care provider, and others as appropriate.
4)Requires the Department of Mental Health to identify or
develop written materials by July 1, 2010 to assist in the
provision of age-appropriate information about psychotropic
medications to minors.
5)Requires that a dependent child or ward in foster care be
present in court for a hearing on the request to administer
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psychotropic medications, unless the child waives the right to
attend after consulting with counsel or the court finds good
cause for his or her absence.
6)Authorizes the court, in proceedings following orders
regarding administration of psychotropic medication to inquire
about:
a) The effectiveness and side effects of the medication,
the child's progress toward treatment goals, and any
changes recommended, as reported by the physician;
b) Any behavior changes and possible side effects observed
by individuals in regular contact with the child; and
c) Any statements or concerns expressed by the child about
the medication.
7)Requires the Judicial Council to adopt rules and forms to
implement the above provisions by July 1, 2010.
EXISTING LAW :
1)Defines psychotropic medication or drugs as those medications
administered for the purpose of affecting the central nervous
system to treat psychiatric disorders or illnesses. (Welfare
and Institutions Code Sections 369.5, 739.5. Unless stated
otherwise, all further statutory references are to this code.)
2)Authorizes only a juvenile court judicial officer to make
orders about the administration of psychotropic medications to
a child who was removed from his or her parent's custody and
declared a dependent of the court, or declared a ward of the
court and placed in foster care, unless the court issues a
specific order delegating that authority to a parent or
guardian after making specified findings. (Sections 369.5,
739.5.)
3)Requires that the juvenile court's authorization to administer
psychotropic medications be based on a physician's request
which includes the reasons for the request, a description of
the child's diagnosis and behavior, the expected results of
the medication, and a description of any side effects of the
medication. (Sections 369.5, 739.5.)
4)Provides that judicial officers have seven days to approve or
deny the request, or to set the matter for a hearing upon
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request by the parent, legal guardian or child's attorney.
(Sections 369.5, 739.5.)
5)Defines prescribing, dispensing, or furnishing dangerous drugs
without an appropriate prior examination and a medical
indication as unprofessional medical conduct, except as
specified. (Business and Professions Code Section 2242.)
COMMENTS : This bill is very similar to AB 2117 (Evans), of
2008, which passed out of this Committee 10-0, but was held in
the Senate Appropriations Committee. The author summarizes the
goal of this bill as the creation of additional safeguards in
the court approval process for requests to administer
psychotropic medication to foster youth. According to the
author, psychotropic medications can be a key component of
effective treatment for conditions affecting some foster youth.
However, the author also notes that in 2006 testimony before the
Blue Ribbon Commission on Children in Foster Care and Select
Committee on Foster Care "some youth reported being put on
medications when they were very young - as young as 4 or 5 years
old - and remaining on various medications for their entire
childhoods. Other youth described being prescribed multiple
medications at the same time. . . Youth reported experiencing
serious side effects - drowsiness, weight gain, insomnia,
drooling, facial tics, etc. - and receiving little or no
monitoring of the effectiveness of their medications. . . .
Other foster youth on medication indicated that they did not
receive effective therapy and/or behavioral interventions that
could have reduced or eliminated the need for medication."
Concerns about potential misuse or overuse of psychotropic
medications for children in foster care continue today.
During the 2006 hearings, representatives of the Department of
Social Services and the Judicial Council testified that there
was little or no aggregated data on the scope of the use of
psychotropic medication for youth in the California foster care
system. While some studies and articles document experts'
concerns about inappropriate or over-medication of children in
foster care, others raise concerns about the potential for
under-medicating youth who might benefit from psychotropic
medications. In general, there appears to be no consensus about
the efficacy or appropriate level of usage of psychotropic
medications for children in the population at large or for
children in foster care; but there seems to be agreement that
careful monitoring of its administration should be practiced.
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The Author is Working on a Technical Clarification for the Bill :
The author's office is working with organizations representing
medical professionals to ascertain the best terminology with
which to describe professionals who are authorized to administer
medications.
Prior Legislation : Existing provisions regarding juvenile court
authority to make orders about the administration of
psychotropic medications to foster children were added by SB 543
(Bowen), Chap. 552, Stats. 1999, in response to concerns about
potential overuse of psychotropic medication for children in
foster care and the inappropriateness of allowing parents whose
children were removed to consent to the use of such medications
(unless the juvenile court specifically determined that they
should have such authority). The timeframe in which the court
must approve, deny or set a hearing about a request was created
by AB 2502 (Keene), Chap. 329, Stats. 2004.
Parallel provisions regarding court authority to make orders
about the administration of psychotropic medications to a ward
of the court who is removed from the physical custody of a
parent and placed into foster care were added by AB 1514 (Maze),
Chap. 120, Stats. 2007.
AB 2117 (Evans, 2008) contained provisions similar to those in
this bill. AB 2117 was held in the Senate Appropriations
Committee. At that time, the bill contained a requirement that
the county child welfare agency or county probation department
include or attach specified information to all reports provided
to the juvenile court following court authorization for the
administration of psychotropic medication to a child.
AB 1330 (Evans, 2007), which was held in the Assembly
Appropriations Committee, would have required the Department of
Social Services to collect and maintain specified information
regarding foster youth who are prescribed psychotropic
medication.
AB 1573 (Niello, 2007), which was held in the Assembly
Appropriations Committee, would have extended a juvenile court
judicial officer's authority to make orders administering
psychotropic medication to wards of the court who had been
removed from the custody of a parent or guardian.
AB 82
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REGISTERED SUPPORT / OPPOSITION :
Support
Children's Law Center of Los Angeles (sponsor)
California Youth Connection
Family Law Section, State Bar of California
Disability Rights California (if amended)
Junior Leagues of California, State Public Affairs Committee
Sacramento Child Advocates
Western Center on Law & Poverty
Youth Law Center
Opposition
None on file
Analysis Prepared by : Leora Gershenzon and Lakeisha Hood / JUD.
/ (916) 319-2334