97TH GENERAL ASSEMBLY
State of Illinois
2011 and 2012
HB0286

 

Introduced 01/28/11, by Rep. Mary E. Flowers

 

SYNOPSIS AS INTRODUCED:
 
New Act

    Creates the Administration of Psychotropic Medications to Children Act. Requires prior approval from an authorized agent before the administration of psychotropic medications to children for whom the Department of Children and Family Services has legal responsibility. Requires authorized agents to receive training on the list of psychotropic medications approved by the Pharmacological Review Committee, a committee created under the Act for the purpose of developing and publishing a manual that lists all Committee approved psychotropic medications, including the purpose of these medications, the acceptable range of dosages, contraindications, and time limits, if any. Contains provisions on medication approval standards; rules governing the administration of psychotropic medications to children housed in residential facilities or facilities run by the Illinois Department of Corrections; on-site inspections of residential facilities; required forms; training requirements; penalties for violators of the Act; and other matters. Effective immediately.


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FISCAL NOTE ACT MAY APPLY

 

 

A BILL FOR

 

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1    AN ACT concerning children.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 1. Short title. This Act may be cited as the
5Administration of Psychotropic Medications to Children Act.
 
6    Section 5. Purpose. The following standards and procedures
7shall govern the administration of psychotropic medications to
8persons under the guardianship of the Department of Children
9and Family Services pursuant to court order or for whom the
10Department has custody and has, by court order or via an
11adoptive surrender, been authorized to consent to major medical
12procedures. It is the purpose of this Act to create a system
13that promptly identifies and evaluates the needs of children
14for psychotropic medications, provides timely access to such
15medications, and monitors children on such medications, while
16recognizing the risks that such medications pose, particularly
17if they are not prescribed and monitored with care.
18Psychotropic medications must not be used simply for the
19convenience of staff members, to punish children, or as a
20substitute for adequate staffing and programming.
 
21    Section 10. Definitions. As used in this Act:
22    "Authorized agent" means a staff member for the Department

 

 

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1of Children and Family Services who has been appointed and
2authorized by the Director of the Department to officially act
3in the place of the Department's Guardianship Administrator to
4authorize and consent to matters concerning children for whom
5the Department has legal responsibility.
6    "Children for whom the Department has legal
7responsibility" means children for whom the Department of
8Children and Family Services has temporary protective custody
9as authorized by the Abused and Neglected Child Reporting Act;
10children for whom the Department has been appointed legal
11custodian or guardian by order of a court of competent
12jurisdiction; children whose parent or parents have signed an
13adoptive surrender; or children for whom the Department has
14temporary custody via a voluntary placement agreement.
15    "Department" means the Illinois Department of Children and
16Family Services.
17    "Director" means the Director of the Illinois Department of
18Children and Family Services.
19    "Emergency" means the existence of circumstances in which a
20child for whom the Department has legal responsibility poses a
21threat of imminent, serious harm to self or others.
22    "IDOC" means the Illinois Department of Corrections.
23    "Pharmacological Review Committee" or "Committee" means a
24committee appointed by the Department that is comprised of at
25least 3 representatives, at least one of whom is a Board
26certified psychiatrist who specializes in the treatment of

 

 

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1children and adolescents.
2    "Psychiatric consultant" means a "psychiatrist" as that
3term is defined in Section 1-121 of the Mental Health and
4Developmental Disabilities Code, who has specialized in child
5and adolescent psychiatry.
6    "Psychotropic medications" means medications whose use for
7antipsychotic, antidepressant, antimanic, antianxiety,
8behavioral modification or behavioral management purposes is
9listed in AMA Drug Evaluations, latest edition, or Physician's
10Desk Reference, latest edition, or that are administered for
11any of these purposes.
12    "Residential facility" means any facility housing one or
13more children for whom the Department of Children and Family
14Services has legal responsibility, regardless of whether that
15facility is located within the State, including but not limited
16to group homes, child care institutions, and inpatient mental
17health facilities, including those operated by the Illinois
18Department of Human Services. Facilities operated by IDOC are
19not residential facilities, as defined in this Act.
 
20    Section 15. General provisions.
21    (a) The administration of psychotropic medications to
22children for whom the Department has legal responsibility as
23punishment for bad behavior, for the convenience of caregivers,
24or as a substitute for adequate ongoing programming for the
25children's needs is prohibited.

 

 

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1    (b) Except in an emergency, and subject to subsection (a)
2of this Section, psychotropic medications shall never be
3administered to children for whom the Department has legal
4responsibility without the prior approval of an authorized
5agent as set forth in this Act. For purposes of consenting to
6the administration of psychotropic medications, the Department
7must be the legal guardian or custodian that has been granted
8the authority to consent to major medical care.
9    (c) In regards to children for whom the Department has
10legal responsibility and who have been committed to facilities
11operated by IDOC, the administration of psychotropic
12medications to these children shall be governed solely by IDOC
13rules as set forth in Part 415 of Title 20 of the Illinois
14Administrative Code and the Unified Code of Corrections. In its
15role as guardian, the Department may contest decisions made by
16IDOC in accordance with IDOC rules regarding the involuntary
17administration of psychotropic medications to Department wards
18placed in facilities operated by IDOC.
19    (d) The Department shall establish a Pharmacological
20Review Committee which shall develop and publish a manual
21entitled the Pharmacy and Therapeutic Manual. The manual shall
22list all acceptable psychotropic medications that are approved
23by the Committee for use with children for whom the Department
24has legal responsibility and shall list their purposes, the
25acceptable range of dosages, contraindications, and time
26limits, if any. The names, qualifications, and professional

 

 

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1positions of Committee members shall be listed on the front
2page of the manual. The Committee shall also review the manual
3on at least an annual basis and make recommendations for
4changes, as necessary.
5    (e) The Pharmacy and Therapeutic Manual and any revisions
6to it shall be provided to all authorized agents and to all
7residential facilities housing children for whom the
8Department has legal responsibility.
9    (f) Authorized agents shall be provided with regular
10periodic training in the use and contents of the manual. The
11Department shall appoint, subject to Committee, a professional
12who specializes in treating children and adolescents to provide
13training to authorized agents on the use of the manual and its
14contents. The training shall include the following:
15        (1) Initial training before the authorized agent
16    assumes the responsibilities of the position. This
17    training shall include an explanation of the manual's
18    purpose, how to use the manual, and the manual's contents,
19    including an explanation of commonly prescribed
20    psychotropic medications, the appropriate dosages for
21    children and adolescents, common side effects, danger
22    signs, illnesses for which medication is commonly
23    prescribed, the discretion left to the authorized agent,
24    and the procedure for approval or denial of a psychotropic
25    medication.
26        (2) Annual training.

 

 

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1        (3) Training before any revisions to the manual take
2    effect.
3    (g) The Department's Guardianship Administrator or his or
4her designee shall review the authorized agent's consents given
5pursuant to this Act within 30 days after the start of the
6authorized agent's use of the manual and at least once every 90
7days thereafter.
8    (h) The Department shall employ or contract with one or
9more psychiatric consultants. Authorized agents shall consult
10with the psychiatric consultant employed or contracted by the
11Department.
12    (i) The Department shall provide the Pharmacological
13Review Committee with statistical and non-identifying data
14regarding the administration of psychotropic medications to
15children governed by this Act including, where applicable, data
16from foster parent licensure reviews and administrative case
17reviews. The Committee shall review such data at least annually
18to determine whether psychotropic medications are being
19administered appropriately and in compliance with this Act. The
20Committee shall determine whether additional or different data
21shall be collected and whether this Act should be modified to
22achieve the goals set forth in this Section.
 
23    Section 20. Medication approval standards.
24    (a) Authorized agents may, at their discretion, approve the
25administration of any psychotropic medication whose use and

 

 

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1dosage is listed in the Pharmacy and Therapeutic Manual,
2provided that children for whom the Department has legal
3responsibility are not taking any other psychotropic
4medications and subject to the provisions of subsection (a) of
5Section 15 of this Act. Authorized agents may approve the
6administration of any psychotropic medication that does not
7meet the criterion listed in this Section only following
8consultation with the Department's psychiatric consultant. The
9authorized agent shall note on the consent form when consent
10has been given for the administration of a psychotropic
11medication that is not listed in the Pharmacy and Therapeutic
12Manual.
13    (b) Whenever the authorized agent is advised that a child
14for whom the Department has legal responsibility objects to the
15administration of a psychotropic medication, the authorized
16agent must consult with both the physician who is recommending
17the medication and the psychiatric consultant employed or
18contracted by the Department prior to approving or denying the
19medication. Authorized agents shall assess the basis for the
20child's objection to the psychotropic medication. This
21assessment may include asking the child's caseworker to
22interview the child to determine the basis for his or her
23objection. The reason for the child's objection must be fully
24documented on the approval form established in subsection (a)
25of Section 25 of this Act.
26    (c) Every authorization for the administration of a

 

 

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1psychotropic medication to a child for whom the Department has
2legal responsibility shall be limited in time. Under no
3circumstance may a psychotropic medication be authorized for a
4period exceeding 180 days. At the expiration of the period set
5forth in the authorization, a psychotropic medication may be
6authorized again pursuant to the standards and procedures
7contained in this Section.
8    (d) Whenever a physician recommends the administration of a
9psychotropic medication to a child for whom the Department has
10legal responsibility, the child shall be advised of the
11purposes and effects of the medication and of the potential
12side effects of the medication to the extent that such advice
13is consistent with the nature and frequency of the side effects
14and the child's ability to understand the information
15communicated. The child shall also be provided written
16information concerning the medication and its side effects,
17unless it has been determined that such information could not
18be understood by the child. This written information shall be
19provided in the child's primary language. Nothing in this
20subsection shall be deemed to create any liability on the part
21of the physician or the residential facility based upon the
22failure to provide the child with complete and accurate
23information. The information required under this subsection to
24be provided to the child shall also be provided to the child's
25parent where (i) parental rights have not been terminated, (ii)
26the Department has information as to how it may communicate

 

 

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1with the parent, (iii) the child has not objected to sharing
2the information with the parent, and (iv) the court has not
3entered an order prohibiting disclosure of this information to
4the parent.
5    (e) Authorized agents retain the authority to deny consent
6to the administration of psychotropic medications to a child
7for whom the Department has legal responsibility, whether or
8not these medications are among those listed in the Pharmacy
9and Therapeutic Manual or whether or not they have been
10approved by the psychiatric consultant. Authorized agents may
11only deny consent to the administration of psychotropic
12medications after consulting both the prescribing physician
13and the psychiatric consultant. The Pharmacy and Therapeutic
14Manual shall contain a statement setting forth this authority.
15In the event of a denial of a medication request, the specific
16reasons for the denial shall be set forth on the Psychotropic
17Medication Approval form established under Section 25 of this
18Act.
19    (f) Authorized agents must render their oral approval or
20denial of a psychotropic medication request within 24 hours
21from the time they receive the request for approval, and shall
22confirm their approval in writing within 2 working days, unless
23the reason for the delay is the unavailability of the
24prescribing physician to consult with the authorized agent. If
25oral approval or denial of the request for medication is not
26rendered within 24 hours from the time the request was

 

 

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1received, the requesting party shall contact the Department's
2Guardianship Administrator or his or her designee for
3assistance in obtaining a response.
 
4    Section 25. Children in residential facilities.
5    (a) The Department shall create and distribute a
6Psychotropic Medication Approval Form. Copies of the form shall
7be distributed to all residential facilities housing wards of
8the Department and to all authorized agents. That form shall
9include the following information:
10        (1) The child's name, age, weight, and diagnosis.
11        (2) The medication to be administered.
12        (3) The dosage and frequency of the medication.
13        (4) The duration of administering the medication,
14    which in no event shall exceed 180 days.
15        (5) Target symptom or symptoms and behavior.
16        (6) Other medication the child is receiving.
17        (7) The potential side effects of the medication which
18    are of greatest concern.
19        (8) The name of the prescribing physician.
20        (9) In the case of children who are 14 years of age or
21    older, whether the ward objects to the administration of
22    the medication.
23    (b) Residential facilities that provide care to children
24for whom the Department has legal responsibility shall be
25advised by the Department that, whenever they seek approval of

 

 

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1an authorized agent for the administration of a psychotropic
2medication, they will be asked the questions listed on the
3Psychotropic Medication Approval Form. The residential
4facility shall complete a copy of the approval form which is to
5be kept in the child's medical file at the facility. Whenever
6approval is granted by an authorized agent, the agent shall
7complete and sign 3 copies of the form, retain one copy for the
8child's case record, and forward copies to the Department's
9Guardianship Administrator or his or her designee and a copy to
10the residential facility where the child resides.
11    (c) Prior consent from an authorized agent is not required
12when an emergency exists. However, the authorized agent shall
13be notified in writing of the administration of a psychotropic
14medication to a child for whom the Department has legal
15responsibility, within one week of its initial administration.
16The Department shall provide each residential facility with
17Emergency Psychotropic Medication forms to be used by the
18residential facility in reporting to the authorized agent the
19administration of emergency medication. This form shall be
20completed by either a registered nurse or a physician who has
21examined the child and shall contain the information set forth
22in subsection (a). Additionally, the form shall require a brief
23explanation of the nature and circumstances of the emergency. A
24copy of this form shall be placed in the child's medical file
25at the residential facility and copies shall be forwarded to
26the Department's Guardianship Administrator or his or her

 

 

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1designee and the authorized agent for the child. Emergency
2medication may not continue for more than 48 hours, excluding
3Saturdays, Sundays and holidays. The administration of a
4psychotropic medication beyond this period may occur only if
5approved by an authorized agent as provided for in this Act.
6    (d) The administration of psychotropic medications shall
7be monitored as follows: The medical director of each
8residential facility, or a designee who has been licensed in
9accordance with the provisions of the Nurse Practice Act, shall
10conduct a monthly review of all psychotropic medications and
11record that review in writing. This record shall be reviewed
12during the on-site inspections required under subsection (f) of
13this Section. During this monthly review, the medical director
14or his or her designee shall conduct an inventory of all
15psychotropic medications and shall verify the following:
16        (1) That the psychotropic medications are labeled with
17    the assigned child's name, directions for administering
18    the medication, the date and prescribing physician's name,
19    the prescription number, and the drug store or pharmacy.
20        (2) That all medications are stored in a locked cabinet
21    or within a locked refrigerator, if required for proper
22    storage.
23        (3) That all controlled substances are accounted for
24    or, if any amount of a controlled substance is missing, an
25    incident report has been filed with the Director of the
26    facility.

 

 

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1        (4) That psychotropic medications are dispensed in
2    accordance with the requirements of the prescription.
3        (5) That written consents for the provision of
4    psychotropic medications have been received from the
5    parent or guardian, as appropriate.
6        (6) That any medications for children who have left the
7    facility or who have been on runaway status 14 days or
8    longer have been properly disposed of.
9    (e) The Department's Guardianship Administrator or his or
10her designee shall collect all emergency psychotropic
11medication forms and all psychotropic medication approval
12forms in binders divided according to residential facility. The
13Department's Guardianship Administrator or his or her designee
14shall review these binders monthly. The psychiatric consultant
15shall also review these binders every 90 days.
16    (f) The Department shall conduct unannounced on-site
17inspections of each residential facility at least annually to
18assure that the approval forms reflect the actual practice in
19the residential facility and that the residential facility is
20in compliance with this Act. Such reviews shall include an
21investigation into whether the emergency psychotropic
22medication forms and the psychotropic medication approval
23forms accurately reflect those minors who have objected to the
24administration of medication.
25    (g) The Department shall offer training at least once every
266 months for personnel employed by residential facilities

 

 

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1concerning the provisions under this Section and the procedures
2through which psychotropic medication may be authorized.
 
3    Section 30. Miscellaneous provisions.
4    (a) The Psychotropic Medication Approval form specified in
5Section 25 of this Act shall be attached as an exhibit to the
6client service plan form for each psychotropic medication which
7is being administered.
8    (b) When a child has a neurological or psychiatric
9condition for which the administration of psychotropic
10medications is likely, the Department shall request from a
11court of competent jurisdiction the power to consent to major
12medical care including specifically the administration of
13psychotropic medications.
14    (c) Minors who have been declared emancipated by any court
15for the purposes of consent to medical treatment shall have the
16qualified right to refuse psychotropic medications as provided
17for adults in Sections 2-107 and 2-107.1 of the Mental Health
18and Developmental Disabilities Code, but subject to subsection
19(c) of Section 15 of this Act.
20    (d) Children for whom the Department has legal
21responsibility and who have reached the age of 18 shall have
22the qualified right to refuse psychotropic medications as
23provided for adults in Sections 2-107 and 2-107.1 of the Mental
24Health and Developmental Disabilities Code, but subject to
25subsection (c) of Section 15 of this Act.
 

 

 

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1    Section 35. Violations; monetary relief. A person who
2administers psychotropic medications to children for whom the
3Department has legal responsibility without obtaining the
4authorization required under this Act or who administers
5psychotropic medications on an emergency basis and fails to
6provide the Department with the notification required under
7this Act shall be liable to the child for the following:
8        (1) Monetary damages in either of the following
9    amounts, whichever is greater: (i) actual damages or (ii)
10    $5,000 for each violation. A separate and distinct
11    violation shall be regarded as committed each day that the
12    person fails to comply with this Act.
13        (2) Punitive damages when the person is found to have
14    willfully violated this Act.
15        (3) Reasonable attorney's fees, costs, and expenses
16    relating to an action brought under this Act.
 
17    Section 40. Liability of employer. When a person who
18violates the authorization or notification requirements set
19forth in this Act does so as an employee of a residential
20facility, both the residential facility and the employee shall
21be jointly and severally liable for the monetary damages,
22punitive damages, reasonable attorney's fees, costs, and
23expenses set forth in Section 35 of this Act.
 

 

 

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1    Section 45. Rights. The rights and remedies provided for in
2this Act are meant to supplant those available under the common
3law as of the effective date of this Act, but do not affect an
4individual's common law rights as they existed before the
5effective date of this Act. The rights and remedies provided
6under this Act are supplemental to any other rights and
7remedies provided by law.
 
8    Section 99. Effective date. This Act takes effect upon
9becoming law.