110 CMR 11.14 - Antipsychotic Drugs

(1) "Antipsychotic drugs" shall mean drugs which are used in treating psychoses. Antipsychotic drugs include the below-listed drugs by whatever official name, common or usual name, chemical name, or brand name they may be designated. All isomers, esters, ethers, salts of, or any combination of, drugs listed below are deemed to be antipsychotic drugs. Such antipsychotic drugs shall include, but shall not be limited to:

Generic Name	Trade Name
1 Acetophenazine	Tindal
2 Butaperazine	Repoise
3 Carphenazine	Proketazine
4 Chlorpromazine	Thorazine
5 Chlorprothizene	Taractan
6 Fluphenazine	Prolixin
7 Haloperidol	Haldol
8 Loxapine	Loxitane
9 Mesoridazine	Serentil
10 Molindone	Moban
11 Perphenazine	Trilafon
12 Piperacetezine	Quide
13 Prochlorperazine	Compazine
14 Promazine	Sparine
15 Thioridazine	Mellaril
16 Thiothixene	Navane
17 Trifluoperazine	Stelazine
18 Triflupromazine	Vesprin

(2) No Consent by Department. The Department shall not consent to the administration of antipsychotic medication for any individual, but shall in all cases seek parental consent for children in Department care, or prior judicial approval for children in Department custody and wards of the Department.

(3) Consent by Parents for Children in Department Care.

(a) When any individual, organization, facility or medical provider seeks to medicate with antipsychotic drugs a child, who is in the care of the Department, Department staff shall not consent to such medication nor shall the Department seek prior judicial approval for administration of such medication. The decision of whether to consent to such medication shall remain with the parents.

(b) If the Department has reason to believe that the parents are guilty of medical neglect by their consent to medicate with antipsychotic drugs or by their refusal to consent to medicate with antipsychotic drugs, the Department shall seek custody of the child through a court proceeding which alleges medical neglect.

(c) The 110 CMR 11.14(3)(a) and (b) apply whether or not the child consents to the administration of antipsychotic medication.

(4) Judicial Approval for Wards and Children in Department Custody.

(a) When any individual, organization, facility, or medical provider seeks the Department's consent to medicate with antipsychotic drugs a child, who is a ward of the Department or who is in Department custody, the Department shall seek prior judicial approval for administration of such drugs even if the child's biological parents have consented to the medication. See Rogers v. Commissioner of the Department of Mental Health, 390 Mass. 489 (1983); M.G.L. c. 210, § 6.

(b) Where antipsychotic medications have been previously prescribed for a child who is a ward of the Department or who is in the custody of the Department, and that child is currently being treated with antipsychotic drugs without judicial authorization, the Department shall initiate the process for judicial review and application of substituted judgment. Pending judicial review the Department shall not discontinue the prescribed treatment with antipsychotic drugs, because interruption or discontinuance of the treatment might cause severe medical complications and might violate the individual's legal right to treatment.

(c) Neither a ward of the Department who has attained 16 years of age nor a child in the custody of the Department who has attained 16 years of age and who has voluntarily admitted themself to a mental health facility, shall have the power to consent to the administration of anti-psychotic drugs. The Department shall seek prior judicial approval for medicating such a child with antipsychotic drugs, even if such child consents to its administration. See M.G.L. c. 201, § 6.

(5) Guardianship for Individuals Over 18 Years of Age.

(a) The Department shall not consent to the administration of antipsychotic drugs to an individual over 18 years of age who is in the care or custody of the Department.

(b) Any individual over 18 years of age who is in the care or custody of the Department, and who is competent to make medical decisions, may consent to the administration of their antipsychotic medication.

(c) If the Department believes that an individual over 18 years of age in the care or custody of the Department is not competent to make medical decisions, and failing action by the individual's parents, the Department of Mental Health, or other third person, the Department will file incompetency proceedings under M.G.L. c. 201. If the individual is adjudicated competent, then only such individual may consent to the administration of antipsychotic drugs. If the individual is adjudicated incompetent then the judge will apply a substituted judgment standard to determine whether antipsychotic drugs ought to be administered, and will issue appropriate orders.

(6) Emergency Treatment with Antipsychotic Drugs.

(a) Antipsychotic drugs may be administered for treatment purposes without parental consent or prior judicial approval only in an emergency (even though no threat of violence exists) and only if there is no less intrusive alternative to antipsychotic drugs.

(b) An emergency for purposes of administering antipsychotic drugs for treatment purposes is an unforeseen combination of circumstances or the resulting state that calls for immediate action. See Roe at 42. It includes a situation where doctors, in their professional judgment, determine that the medication is necessary to prevent the immediate, substantial, and irreversible deterioration of a serious mental illness. See Rogers at 511. The possibility that a mental condition might deteriorate into a chronic, irreversible condition at an uncertain but relatively distant date is not an emergency. See Roe at 55.

(c) In situations that fall within the purview of 110 CMR 11.00, no consent by the Department or parents is necessary (since the medical provider may make such determination) and therefore the Department shall not give consent nor seek parental consent.

(d) If a child is medicated with antipsychotic drugs in an emergency situation and the doctors determine that the antipsychotic drugs should continue, then the Department shall follow the procedures for obtaining consent as though no emergency existed. See Rogers at 512.

(7) Use of Antipsychotic Drugs for Restraint.

(a) Antipsychotic drugs shall not be administered as a restraint of any ward or child in the care or custody of the Department when such restraint is for disciplinary reasons or for administrative convenience.

(b) Antipsychotic drugs may be used for restraint only in cases of emergency, and only if there is no less intrusive alternative to antipsychotic drugs. An emergency for purposes of administering antipsychotic drugs for restraint is the occurrence of, or serious threat of, extreme violence, personal injury, or attempted suicide. Such emergency cases shall only include situations where there is the occurrence or a substantial risk of serious self-destructive behavior, or the occurrence or a substantial risk of serious physical assault. A substantial risk includes only the serious, imminent threat of bodily harm, where there is present ability to effect such harm. Predictable crises are not within the definition of emergency. Antipsychotic drugs may be administered for restraint only in accordance with the procedures set forth in 104 CMR (Department of Mental Health).

Notes

110 CMR 11.14

Amended by Mass Register Issue 1475, eff. 8/5/2022.