TITLE 20: CORRECTIONS, CRIMINAL JUSTICE, AND LAW ENFORCEMENT
Section 2415.15 Responsibilities
a) Unless otherwise specified, the Director, Chief Administrative Officer, or Agency Medical Director may delegate responsibilities stated in this Part to another person or persons or designate another person or persons to perform the duties specified.
b) No other individual may routinely perform duties whenever a rule in this Part specifically states the Director, Chief Administrative Officer, or Agency Medical Director shall personally perform the duties. However, the Director, Chief Administrative Officer, or Agency Medical Director may designate another person or persons to perform the duties during periods of his or her temporary absence or in an emergency.
Section 2415.20 Definitions
a) "Agency Medical Director" means the Medical Director of the Department of Juvenile Justice.
b) "Chief Administrative Officer" means the highest ranking official of a youth center.
c) "Communicable disease" means a disease caused by an organism that is transmitted through airborne means or casual contact, or through blood or bodily secretion contact from one human being to another.
d) "Department" means the Department of Juvenile Justice.
e) "Department physician or dentist" means any physician or dentist who provides services for the Department.
f) "Director" means the Director of the Department of Juvenile Justice.
g) "Gravely disabled" means a condition in which a youth, as a result of a mental illness or mental disorder:
1) Is in danger of serious physical harm resulting from the person's failure to provide for his or her essential human needs of health or safety; or
2) Manifests serious deterioration in routine functioning evidenced by repeated and escalating loss of cognitive or volitional control over the person's actions that is likely to seriously jeopardize his or her health or safety.
h) "Likelihood of serious harm" means:
1) A substantial risk that physical harm will be inflicted by a youth upon his or her own person as evidenced by, among other things, threats or attempts to commit suicide or inflict physical harm on one's self; or
2) A substantial risk that physical harm will be inflicted by a youth upon another as evidenced by, among other things, behavior that has caused such harm or that places another person or persons in reasonable fear of sustaining such harm; or
3) A substantial risk that physical harm will be inflicted by a youth upon the property of others as evidenced by, among other things, behavior that has caused substantial loss or damage to the property of others.
i) "Mental health professional" means a psychiatrist, physician, psychiatric nurse, clinically trained psychologist, or an individual who has clinical training and a master's degree in social work or psychology.
j) "Physician" means an individual who is licensed by the State of Illinois to practice medicine in all of its branches.
k) "Specialized mental health setting" means a Department of Juvenile Justice youth center or unit that specializes in mental health care.
Section 2415.30 Medical and Dental Examinations and Treatment
a) Within seven working days after admission to a reception and classification center, each youth shall be given a physical examination by a physician or by a nurse practitioner under the direct supervision of a physician or by a physician's assistant under the direct supervision of a physician. Each youth shall be immunized as prescribed by the physician.
b) Each youth shall be examined by a dentist within 10 working days after admission to a reception and classification center. The dentist shall chart the oral cavity and classify dental health.
c) Emergency treatment shall be available to youth 24 hours a day.
d) A health care unit or area shall be established at each youth center within the Department. Youth shall be admitted to the health care unit or area as determined by health care personnel.
e) Youth shall be informed of the institutional procedures for obtaining medical, dental, or mental health services.
f) Youth shall be provided medical and dental treatment, with the consent of the parent or guardian where applicable, as prescribed by a Department physician or dentist.
g) A youth who has or is suspected of having a communicable disease may be isolated from other youth. This determination shall be made by a physician as deemed medically necessary.
h) In case of critical illness or major surgery, the Chief Administrative Officer shall:
1) Attempt to notify the person designated by the youth to be contacted in case of an emergency and, where applicable, the parent or guardian.
2) Notify the Chief Legal Counsel if consent for treatment is not obtained or other legal issues arise.
3) Notify the Agency Medical Director.
i) The decision to continue or terminate a pregnancy is a medical determination that shall be made by the youth in consultation with her physician.
1) Youth contemplating an abortion shall be provided with information and counseling concerning the nature of, the consequences of, and any risks associated with the procedure and available alternatives.
2) Youth shall be granted a furlough for the purpose of obtaining an abortion. Youth shall be permitted to accept funds for an abortion from local community charities or other sources.
j) Youth shall be offered testing and related counseling for HIV following transfer from reception and classification and prior to release, discharge, or parole.
k) A record of all medical and dental examinations, findings, and treatment shall be maintained.
Section 2415.40 Mental Health Services
a) Youth committed to the Department shall have access to mental health services as determined by a mental health professional.
b) Community mental health services offered through the Department for youth released on aftercare shall be provided in accordance with 59 Ill. Adm. Code 132, Medicaid Community Mental Health Services. Such services shall be provided by entities that are Medicaid certified and periodically reviewed by the Department or by the Department of Human Services in accordance with 59 Ill. Adm. Code 132.
Section 2415.50 Mental Health Examinations and Treatment for Guilty but Mentally Ill
a) Within 48 hours after admission to a reception and classification center, each youth adjudicated guilty but mentally ill shall be screened by a mental health professional.
b) An examination by a licensed or registered mental health professional shall be performed on a youth adjudicated guilty but mentally ill within four days after the youth's admission to a reception and classification center. The purpose of the examination is to determine the mental health status of the individual at the time of admission to the Department and to make any appropriate recommendations necessary for the care of such individuals. Youth so examined:
1) Who demonstrate acute symptoms of mental illness or who are determined to be dangerous to self or others shall be treated in accordance with the procedures applicable to other youth. Treatment may include routine or emergency placement in a specialized mental health setting. Youth placed in a specialized mental health setting shall remain as long as determined to be clinically necessary.
2) Who are determined not to be in need of placement in a specialized mental health setting may receive necessary treatment services in a general institutional setting when such services are clinically recommended by a mental health professional.
3) Who are found to be symptom free or in remission at the time of admission to the Department and are not in need of mental health treatment shall be placed in a general institutional setting.
c) Once placed in a general institutional setting, these youth shall be examined or evaluated by a mental health professional at a minimum of every three months for the first six months and then every six months thereafter.
1) These youth may be referred by appropriate staff or may request an examination or evaluation more frequently.
2) More frequent evaluations may also be performed at the discretion of the examining mental health professional as determined to be clinically necessary.
d) Three months prior to the scheduled release date of a youth adjudicated guilty but mentally ill, an evaluation by a mental health professional shall be conducted to assess the person's post-release treatment needs, that may include residential care, out-patient counseling, psychotropic medication, periodic psychiatric or psychological evaluation, high level parole supervision or aftercare release, commitment to Department of Human Services, or other supportive services (e.g., sheltered workshops, group homes, or vocational training and assistance in obtaining needed treatment or services).
1) If the youth has received psychotropic medication within the previous 12 months, this report must include a psychiatric evaluation of the need for medication or psychiatric monitoring.
2) A copy of the report shall be provided to the appropriate field service office.
e) Within 30 days before the scheduled release date of a youth adjudicated guilty but mentally ill, a final evaluation by a mental health professional shall be conducted to determine whether any changes in the youth's mental or emotional status may affect the previous evaluation of the offender's post-release treatment needs. A report shall be prepared and forwarded to the appropriate field service office no later than seven days prior to the youth's scheduled release date.
Section 2415.60 Review of Placements in a Specialized Mental Health Setting
a) A review of each youth placed at a specialized mental health setting shall be made at least once every six months.
1) The review shall be conducted by a staff psychiatrist and the Administrator of the mental health center or unit or designee.
2) Written results of the review shall be given to the youth.
3) If the recommendation is for the youth to continue in the program at the mental health center or unit, the individual may request a review of that decision by the Placement Review Board.
A) The Placement Review Board shall be composed of three members appointed by the Director. One member shall be a mental health professional and one member shall not be employed by the Department.
B) The Placement Review Board shall review all psychiatric records and may interview the petitioner. The Board may call any employee or other person to present information determined to be relevant to the review.
C) An agreement by a majority of the Board shall be considered the decision of the Board.
D) The decision shall be delivered to the youth in writing.
b) A request for a review hearing may be made at any time by a youth placed at a specialized mental health setting and must be granted at least once every six months.
Section 2415.70 Involuntary Administration of Psychotropic Medication
a) Administration of Psychotropic Medication
1) Psychotropic medication shall not be administered to any youth against his or her will or without the consent of the parent or guardian of a minor who is under the age of 18, unless:
A) A psychiatrist, or in the absence of a psychiatrist a physician, has determined that:
i) The youth suffers from a mental illness or mental disorder; and
ii) The medication is in the medical interest of the youth; and
iii) The youth is either gravely disabled or poses a likelihood of serious harm to self or others; and
B) The administration of such medication has been approved by the Treatment Review Committee after a hearing (see subsection (b) of this Section). However, no such approval or hearing shall be required when the medication is administered in an emergency situation. An emergency situation exists whenever the required determinations listed in subsection (a)(1)(A) of this Section have been made and a psychiatrist, or in the absence of a psychiatrist a physician, has determined that the youth poses an imminent threat of serious physical harm to self or others. In all emergency situations, the procedures set forth in subsection (e) of this Section shall be followed.
2) Whenever a physician orders the administration of psychotropic medication to a youth against the person's will, the physician shall document in the youth's medical file the facts and underlying reasons supporting the determination that the standards in subsection (a)(1) of this Section have been met and:
A) The Chief Administrative Officer shall be notified as soon as practicable; and
B) Unless the medication was administered in an emergency situation, the Chairperson of the Treatment Review Committee shall be notified in writing within three days.
b) Treatment Review Committee Procedures
The Treatment Review Committee shall be comprised of two members appointed by the Chief Administrative Officer, both of whom shall be mental health professionals and one of whom shall be a physician. One member shall serve as Chairperson of the Committee. Neither of the Committee members may be involved in the current decision to order the medication. The members of the Committee shall have completed a training program in the procedural and mental health issues involved that has been approved by the Agency Medical Director.
1) The Chief Administrative Officer shall designate a member of the program staff not involved in the current decision to order medication to assist the youth. The staff assistant shall have completed a training program in the procedural and mental health issues involved that has been approved by the Agency Medical Director.
2) The youth and staff assistant shall receive written notification of the time and place of the hearing at least 24 hours prior to the hearing. The notification shall include the tentative diagnosis and the reasons why the medical staff believes the medication is necessary. The staff assistant shall meet with the youth prior to the hearing to discuss the procedural and mental health issues involved.
3) The youth shall have the right to attend the hearing unless the Committee determines that it is likely that the youth's attendance would subject the youth to substantial risk of serious physical or emotional harm or pose a threat to the safety of others. If such a determination is made, the facts and underlying reasons supporting the determination shall be documented in the youth's medical file. The staff assistant shall appear at the hearing whether or not the youth appears.
4) The documentation in the medical file referred to in subsection (a)(2) of this Section shall be reviewed by the Committee and the Committee may request the physician's personal appearance at the hearing.
5) Prior to the hearing, witnesses identified by the youth and the staff assistant may be interviewed by the staff assistant after consultation with the youth as to appropriate questions to ask. Any such questions shall be asked by the staff assistant unless cumulative, irrelevant, or a threat to the safety of individuals or the security of the youth center.
6) Prior to the hearing, the youth and the staff assistant may request in writing that witnesses be interviewed by the Committee and may submit written questions for witnesses to the Chairperson of the Committee. These questions shall be asked by the Committee unless cumulative, irrelevant, or a threat to the safety of individuals or the security of the facility. If any witness is not interviewed, a written reason shall be provided.
7) Prior to the hearing, the youth and the staff assistant may request in writing that witnesses appear at the hearing. Any such request shall include an explanation of what the witnesses would state. Reasonable efforts shall be made to have such witnesses present at the hearing, unless their testimony or presence would be cumulative, irrelevant, or a threat to the safety of individuals or the security of the facility, or for other reasons including, but not limited to, unavailability of the witness or matters relating to institutional order. In the event requested witnesses are unavailable to appear at the hearing but are otherwise available, they shall be interviewed by the Committee as provided for in subsections (b)(6) and (9) of this Section.
8) At the hearing, the youth and the staff assistant may make statements and present documents that are relevant to the proceedings. The staff assistant may direct relevant questions to any witnesses appearing at the hearing. The youth may request that the staff assistant direct relevant questions to any witnesses appearing at the hearing and the staff assistant shall ask such questions unless cumulative, irrelevant, or a threat to the safety of individuals or the security of the facility.
9) The Committee shall make such investigation as it deems necessary. The staff assistant shall be informed of any investigation conducted by the Committee and shall be permitted to direct relevant questions to any witnesses interviewed by the Committee. The staff assistant shall consult with the youth regarding any statements made by witnesses interviewed by the Committee and shall comply with requests by the youth to direct relevant questions to such witnesses unless cumulative, irrelevant, or a threat to the safety of individuals or the security of the facility.
10) The Committee shall consider all relevant information and material that has been presented in deciding whether to approve administration of the medication.
11) A written decision shall be prepared and signed by all members of the Committee that contains a summary of the hearing and the reasons for approving or disapproving the administration of the medication. Copies of the decision shall be given to the youth, the staff assistant, and the Chief Administrative Officer. Any decision by the Committee to approve involuntary administration of psychotropic medication must be unanimous. The Chief Administrative Officer shall direct staff to comply with the decision of the Committee.
12) If the Committee approves administration of the medication, the youth shall be advised of the opportunity to appeal the decision to the Agency Medical Director by filing a written appeal with the Chairperson within five days after the youth's receipt of the written decision.
c) Review by Agency Medical Director
1) If the youth appeals the Treatment Review Committee's decision, staff shall continue to administer the medication as ordered by the physician and approved by the Committee while awaiting the Agency Medical Director's decision on the appeal.
2) The Chairperson of the Committee shall promptly forward the written notice of appeal to the Agency Medical Director or a physician designated by the Agency Medical Director.
3) Within five working days after receipt of the written notice of appeal, the Agency Medical Director shall:
A) Review the Committee's decision, make such further investigation as deemed necessary, and submit a written decision to the Chief Administrative Officer; and
B) Provide a copy of the written decision to the youth, the staff assistant, and the Chairperson of the Committee.
4) The Chief Administrative Officer shall direct staff to comply with the decision of the Agency Medical Director.
d) Periodic Review of Medication
1) Whenever any youth has been involuntarily receiving psychotropic medication continuously or on a regular basis for a period of six months, the administration of such medication shall, upon the youth's written request, be reviewed by the Treatment Review Committee in accordance with the procedures enumerated in subsections (b) and (c) of this Section. Every six months thereafter, for so long as the involuntary medication continues on a regular basis, the youth shall have the right to a review hearing upon written request.
2) Every youth who is involuntarily receiving psychotropic medication shall be evaluated by a psychiatrist at least every 30 days, and the psychiatrist shall document in the youth's medical file the basis for the decision to continue the medication.
e) Emergency Procedures
Subsequent to the involuntary administration of psychotropic medication in an emergency situation:
1) The basis for the decision to administer the medication shall be documented in the youth's medical file and a copy of the documentation shall be given to the youth and to the Agency Medical Director for review.
2) A mental health professional shall meet with the youth to discuss the reasons why the medication was administered and to give the youth an opportunity to express any concerns he or she may have regarding the medication.
Copies of all notifications and written decisions shall be placed in the youth's medical file.
A youth may submit a grievance concerning the involuntary administration of psychotropic medication directly to the Administrative Review Board in accordance with 20 Ill. Adm. Code 2504.Subpart F. In considering the grievance, the Board shall confer with the Agency Medical Director.
h) Treatment of Minors
In the case of a youth who is a minor under the age of 18, the parent or guardian shall be sent the documentation and written decisions that are provided to the youth pursuant to this Section and shall be permitted to attend and participate in any proceedings required by this Section. Notice of any Treatment Review Committee hearing shall be promptly sent to the parent or guardian and reasonable attempts shall be made to provide such notice at least 72 hours prior to the hearing.
Section 2415.80 Organ Transplants
a) The Department shall grant a medical furlough for purposes of obtaining an organ transplant if:
1) The youth or the parent or guardian of a minor who is under the age of 18 has made all necessary arrangements with the organ transplant facility, including application for eligibility as a recipient of an organ donor and appropriate financial arrangements. The youth must be accepted by an approved organ transplant facility prior to approval of the medical furlough;
2) The Agency Medical Director confirms that the youth would be a suitable candidate for an organ transplant that is needed to preserve the youth's life or prevent irreparable harm; and
3) The organ transplant facility is approved by the Agency Medical Director and the Chief Administrative Officer.
b) The youth or the parent or guardian of a minor who is under the age of 18 shall be responsible for the cost of the organ transplant procedure, including but not limited to pre-transplant evaluations performed by the transplant facility, the hospital stay, the physicians' services and other medical services involved. The youth shall be permitted to accept funds for the organ transplant from local community charities or other sources. The cost of the transportation and security for the youth shall be paid by the youth, whenever possible.
c) The Department shall direct the youth or the parent or guardian of a minor who is under the age of 18 to the organ transplant facilities and known sources of funding associated with an organ transplant.
d) Use of in-State transplant facilities is preferred. Out-of-State facilities shall be considered if no in-State facility is available and if the youth or the parent or guardian of a minor who is under the age of 18 signs a waiver of extradition.