Utah Admin. Code R523-8-4 - Medication Procedures for Children, Legal Authority
(1) The Division hereby establishes due
process procedures for children prior to the administration of antipsychotic
medication.
(a) This policy applies to
persons under the age of 18 who are committed to the physical custody of a
local mental health authority and/or committed to the legal custody of the
Division.
(b) A person under the
age of 18 may be treated with antipsychotic medication when, as provided in
this section, any one or more of the following exist:
(i) The child and guardian give
consent.
(ii) The child or the
guardian does not give consent, but a Designated Examiner determines that
antipsychotic medication is an appropriate treatment through a due process
proceeding as described in Section
62A-15-704.
(iii) The medication is necessary in order to
control the child's dangerous behavior and it is administered for an exigent
circumstance according to Subsection
R523-8-4(1)(f)
below.
(c) A local
mental health authority has the obligation to provide a child and guardian with
the following information when recommending that the child be treated with
antipsychotic medications:
(i) The nature of
the child's mental illness.
(ii)
The recommended medication treatment, its purpose, the method of
administration, and dosage recommendations.
(iii) The desired beneficial effects on the
child's mental illness as a result of the recommended treatment.
(iv) The possible or probable mental health
consequences to the child if recommended treatment is not
administered.
(v) The possible side
effects, if any, of the recommended treatment.
(vi) The ability of the staff to recognize
any side effects which may actually occur and the possibility of ameliorating
or abating those side effects.
(vii) The possible, if any, alternative
treatments available and whether those treatments are advisable.
(viii) The right to give or withhold consent
for the proposed medication treatment.
(ix) When informing a child and their
guardian that they have the right to withhold consent the staff must inform
them that the mental health authority has the right to initiate a medication
hearing and have a designated examiner determine whether the proposed treatment
is necessary.
(d) The
child and guardian shall then be afforded an opportunity to sign a consent form
stating that they have received the information under Subsection
R523-8-4(1)(c),
and that they consent to the proposed medication treatment.
(e) If either the child or guardian refuses
to give consent, the mental health authority may initiate a medication hearing
in accordance with Subsection
R523-8-4(1)(g).
(f) Antipsychotic medication may be
administered under the following exigent circumstances:
(i) A qualified physician has determined and
certifies that they believe the child is likely to cause injury to themselves
or to others if not immediately treated. That certification shall be recorded
in the Physician's Orders of the child's medical record and shall contain at
least the following information:
(A) A
statement by the physician that they believe the child is likely to cause
injury to themselves or others if not immediately restrained and provided
medication treatment.
(B) The basis
for that belief, including a statement of the child's behaviors.
(C) The medication administered.
(D) The date and time the medication was
begun.
(g)
Involuntary treatment in exigent circumstances may be continued for 48 hours,
excluding Saturdays, Sundays, and legal holidays. At the expiration of that
time period, the child shall not be involuntarily treated unless a Notice to
Convene a Medication Hearing has been prepared and provided to the child
pursuant to the provision of Subsection
R523-8-4(1)(h).
(h) If the child or guardian
refuse to give consent the treating staff may request a medication hearing be
held to determine if medication treatment is appropriate.
(i) The treating physician shall document in
the child's medical record, the child's diagnosis, the recommended treatment,
the possible side effects of such treatment, the desired benefit of such
treatment, and the prognosis.
(ii)
The treating staff shall complete a Request to Convene a Medication Hearing
form and submit it to the Director/Designee of the local mental health
authority who will contact a Neutral and Detached Fact Finder and set a date
and time for the hearing. The child and guardian shall be provided notice of
the medication hearing and the hearing shall be set as soon as reasonably
possible after a request has been made, but no sooner than 24 hours of
notification being provided to the child and guardian.
(iii) Prior to the hearing, the Neutral and
Detached Fact Finder is provided documentation regarding the child's mental
condition, including the child's medical records, physician's orders,
diagnosis, nursing notes, and any other pertinent information.
(i) Medication hearings shall be
conducted by a Neutral and Detached Fact Finder, shall be heard where the child
is currently being treated, and shall be conducted in an informal,
non-adversarial manner as to not have a harmful effect upon the child.
(i) The child has the right to attend the
hearing, have an adult informant (guardian /foster parent, etc.) present, and
to ask pertinent questions. Other persons may attend the hearing if
appropriate.
(ii) The Neutral and
Detached Fact Finder shall begin each medication hearing by explaining the
purpose and procedure of the hearing to the child, guardian, and any other
persons present.
(iii) The Neutral
and Detached Fact Finder will review the child's current condition and
recommended course of treatment.
(iv) The child, guardian, and others present
shall then be afforded an opportunity to comment on the issue of medication
treatment.
(v) Following the
review of the case and hearing of comments, the Neutral and Detached Fact
Finder shall render a decision.
(vi) If needed, the Neutral and Detached Fact
Finder may ask everyone to leave the room to allow them time to
deliberate.
(j) The
Neutral and Detached Fact Finder may order medication treatment of a child if,
after consideration of the record and deliberation, the Neutral and Detached
Fact Finder finds that the following conditions exist:
(i) The child has a mental illness;
and
(ii) The child is gravely
disabled and in need of medication treatment for the reason that they suffer
from a mental illness such that they (a) are in danger of serious physical harm
resulting from a failure to provide for their essential human needs of health
or safety, or (b) manifest severe deterioration in routine functioning
evidenced by repeated and escalating loss of cognitive or volitional control
over their actions and is not receiving such care as is essential for their
health safety; and/or
(iii) Without
medication treatment, the child poses a likelihood of serious harm to
themselves, others, or their property. Likelihood of serious harm means either
(a) substantial risk that physical harm will be inflicted by an individual upon
their own person, as evidenced by threats or attempts to commit suicide or
inflict physical harm on one's own self, or (b) a substantial risk that
physical harm will be inflicted by an individual upon another, as evidenced by
behavior which has caused such harm or which placed another person or persons
in reasonable fear of sustaining such harm, or (c) a substantial risk that
physical harm will be inflicted by an individual upon the property of others,
as evidenced by behavior which has caused substantial loss or damage to the
property of others; and
(iv) The
proposed medication treatment is in the medical best interest of the patient,
taking into account the possible side effects as well as the potential benefits
of the treatment; and
(v) The
proposed medication treatment is in accordance with prevailing standards of
accepted medical practice.
(k) The basis for the decision is supported
by adequate documentation. The Neutral and Detached Fact Finder shall complete
and sign a Medication Hearing form at the end of the hearing. A copy shall be
provided to the child and/or guardian.
(l) A child or guardian may appeal the
decision of a Neutral and Detached Fact Finder according to the following
process, by submitting a written appeal to the Director/Designee of the Local
Mental Health Authority providing treatment to the child, within 24 hours
(excluding Saturdays, Sundays, and legal holidays) of the initial hearing.
(i) Upon receipt of the appeal, a panel
consisting of two physicians and a non-physician licensed professional (RN,
LCSW, PhD, etc.) shall be assigned to hear the appeal.
(ii) The panel shall review the available
documentation and make a decision within 48 hours (excluding Saturdays,
Sundays, and legal holidays) of the date of the appeal.
(iii) A written decision from the panel shall
be provided to the child, the child's guardian, the local mental health
authority providing treatment to the child, and any other appropriate
party.
(m) In the event
that a significant medication change is proposed, the child and/or guardian
shall be provided an opportunity to give consent in accordance to Subsection
R523-8-4(1)(c)
of this section. If the child and guardian refuse to give consent, a medication
hearing may be initiated in according with Subsection
R523-8-4(1)(h)
of this section.
(n) Medication
treatment ordered pursuant to Subsection
R523-8-4(1)(h)
of this section may continue after the initial hearing according to the
following process:
(i) A Neutral and Detached
Fact Finder shall review the case within 180 days of the initial
hearing.
(ii) The Neutral and
Detached Fact Finder shall review the medical record before rendering a
decision to continue medication treatment.
(iii) The Neutral and Detached Fact Finder
may order continued medication treatment if they find the following conditions
are met:
(A) The child is still mentally ill;
and
(B) Absent continued medication
treatment, the child will suffer severe and abnormal mental and emotional
distress as indicated by recent past history, and will experience deterioration
in their ability to function in the least restrictive environment, thereby
making them a substantial danger to themselves or others, and
(C) The medication treatment is in the
medical best interest of the patient, taking into account the possible side
effects as well as the potential benefits of the treatment; and
(D) The medication treatment is in accordance
with prevailing standards of accepted medical practice.
(iv) If the neutral and Detached Fact Finder
approves continued medication treatment, they shall complete a Review of
Continued Medication form, which shall be placed in the child's medical record.
A copy shall be provided to the child and/or guardian.
(v) At the end of 12 months, the case shall
again be reviewed as outlined in this Subsection
R523-8-4(1)(n),
and shall be reviewed every 6 months while the course of treatment is being
administered.
Notes
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