BILL ANALYSIS
SENATE HUMAN
SERVICES COMMITTEE
Senator Carol Liu, Chair
BILL NO: AB 82
A
AUTHOR: Evans
B
VERSION: June 1, 2009
HEARING DATE: June 23, 2009
8
FISCAL: To Judiciary and to Appropriations
2
CONSULTANT:
Lane
SUBJECT
Dependent children: psychotropic medications
SUMMARY
Establishes a pilot project that adds requirements before a
juvenile court can authorize the administration of
psychotropic medications to children in foster care.
ABSTRACT
Current law
1)Establishes processes for a court to declare dependency
for juveniles who are abused or neglected or at risk of
abuse or neglect (dependents) and for juveniles who are
truant (wards).
2)Defines psychotropic medication as those administered for
the purpose of affecting the central nervous system to
treat psychiatric disorders or illnesses. [Welfare and
Institutions Code (WIC) Sections 369.5 and 739.5]
3)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,
unless the court issues a specific order delegating that
Continued---
STAFF ANALYSIS OF ASSEMBLY BILL 82 (Evans) Page
2
authority to a parent or guardian after making specified
findings; establishes a similar authorization for a ward
of the court.
4)Requires that the juvenile court's authorization to
administer psychotropic medications be based on a
physician's request that 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.
5)Provides that judicial officers have seven days to
approve or deny the request, or to set the matter for a
hearing upon request by the parent, legal guardian, or
child's attorney.
6)Defines prescribing, dispensing, or furnishing dangerous
drugs without an appropriate prior examination and a
medical indication as unprofessional medical conduct.
(Business and Professions Code Section 2242)
This bill
1)Establishes a pilot project operative until January 1,
2013, in three counties, one each from the northern,
southern, and central areas of the state and each with a
population of less than two million five hundred thousand
(2,500,000), to be selected by the Department of Social
Services (DSS).
2)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.
3)Specifies that the juvenile court may issue a specific
order delegating this authority to a parent or guardian
upon making findings on the record that the parent or
guardian poses no danger to the child and has the
capacity to authorize psychotropic medications.
4)Requires physicians 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
STAFF ANALYSIS OF ASSEMBLY BILL 82 (Evans) Page
3
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.
5)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.
6)Requires that a dependent child or ward in foster care be
present in court for a hearing on the request to
administer 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.
7)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.
STAFF ANALYSIS OF ASSEMBLY BILL 82 (Evans) Page
4
8)Requires the Judicial Council to adopt rules and forms to
implement the above provisions by July 1, 2010.
9)Requires DSS, after consultation with the Department of
Mental Health, to report to the Legislature before July
1, 2013, regarding the findings of the pilot project.
FISCAL IMPACT
According to the Assembly Appropriations Committee, annual
costs likely in the range of $500,000 ($250,000 General
Fund) for the workload associated with three counties
conducting the pilot project and DSS providing a final
report.
BACKGROUND AND DISCUSSION
Pilot Project
Currently, dependent children receive psychotropic
medications through a structured process: doctors submit a
medication authorization request to the court; foster
children, parents, and their attorneys receive notice and
can request a hearing; and, the court decides whether to
authorize the medication.
In three pilot counties, doctors will be required to
consider the child's medical history and conduct a thorough
examination of the child before they submit the
authorization request (in compliance with general laws
requiring an appropriate examination before prescribing any
medication). Doctors will also be required to indicate on
the authorization request form all other kinds of therapy
that the child should receive along with the medication.
Juvenile court judges, before approving medications, must
ensure that the child and caregiver have been informed
about the medication and about their right to a hearing;
that the child is present at any hearing about the
medication request; and, that a plan is in place to monitor
the medication after approval.
Purpose of this bill
The author states the goal of this bill is to create
additional safeguards in the court approval process for
STAFF ANALYSIS OF ASSEMBLY BILL 82 (Evans) Page
5
requests to administer psychotropic medication to foster
youth. According to the author, psychotropic medications
can be effective treatment for conditions affecting some
foster youth. However, the author believes there is a need
to create additional safeguards. The author cites a 2006
report by the Blue Ribbon Commission on Foster Care
regarding youths' testimony of their experience with
psychotropic medications. "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."
Debate surrounding psychotropic medications
According to the author, there is little aggregated data on
the scope of the use of psychotropic medication for youth
in the foster care system. While some studies and articles
document experts' concerns about inappropriate and
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,
the author states, there is 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.
Prior legislation
In 1999, in response to concerns about potential overuse of
psychotropic medication for children in foster care, the
Legislature passed SB 543 (Bowen, Chapter 552, Statutes of
1999). In 2007, the Legislature added provisions regarding
court authority to make orders about the administration of
psychotropic medications to a ward of the court placed into
foster care (AB 1514, Maze, Chapter 120, Statutes of 2007).
The Department of Social Services sponsored that bill to
remedy disparities between the way wards in foster care and
dependents in foster care may be prescribed psychotropic
medications.
STAFF ANALYSIS OF ASSEMBLY BILL 82 (Evans) Page
6
AB 2117 (Evans) of 2008, which was held in the Senate
Appropriations Committee, contained provisions similar to
the provisions of this bill.
Requested amendments
The County Welfare Directors Association (CWDA), while
supporting the measure, is requesting two amendments to the
bill: first, to require DSS to work with CWDA in the
selection of the pilot counties, and, second, to maintain
in pilot counties current procedures for providing
medication, including psychotropic medication, on an
emergency basis. If the author or the committee believes
that either or both of these amendments are in order, staff
recommends that the author promise to offer these
amendments in the Judiciary Committee, to which the bill is
referred if it passes the Human Services Committee.
Previous votes
Assembly Floor 78-0
Assembly Appropriations 17-0
Assembly Judiciary 10-0
Assembly Human Services 7-0
POSITIONS
Support: Children's Law Center of Los Angeles
(sponsor)
California Youth Connection
County Welfare Directors Association
Family Law Section, State Bar of
California
Junior Leagues of California State
Public Affairs Committee
Sacramento Child Advocates
Western Center on Law and Poverty
Youth Law Center
Oppose: None received.
STAFF ANALYSIS OF ASSEMBLY BILL 82 (Evans) Page
7
-- END --