Bill Text: IL HB5279 | 2009-2010 | 96th General Assembly | Introduced

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Bill Title: 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.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Introduced - Dead) 2010-03-30 - Fiscal Note Filed [HB5279 Detail]

Download: Illinois-2009-HB5279-Introduced.html

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96TH GENERAL ASSEMBLY State of Illinois 2009 and 2010 HB5279 Introduced 2/3/2010, 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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AN ACT concerning children.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 1. Short title. This Act may be cited as the
Administration of Psychotropic Medications to Children Act.
Section 5. Purpose. The following standards and procedures
shall govern the administration of psychotropic medications to
persons under the guardianship of the Department of Children
and Family Services pursuant to court order or for whom the
Department has custody and has, by court order or via an
adoptive surrender, been authorized to consent to major medical
procedures. It is the purpose of this Act to create a system
that promptly identifies and evaluates the needs of children
for psychotropic medications, provides timely access to such
medications, and monitors children on such medications, while
recognizing the risks that such medications pose, particularly
if they are not prescribed and monitored with care.
Psychotropic medications must not be used simply for the
convenience of staff members, to punish children, or as a
substitute for adequate staffing and programming.
Section 10. Definitions. As used in this Act:
"Authorized agent" means a staff member for the Department

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of Children and Family Services who has been appointed and
authorized by the Director of the Department to officially act
in the place of the Department's Guardianship Administrator to
authorize and consent to matters concerning children for whom
the Department has legal responsibility.
"Children for whom the Department has legal
responsibility" means children for whom the Department of
Children and Family Services has temporary protective custody
as authorized by the Abused and Neglected Child Reporting Act;
children for whom the Department has been appointed legal
custodian or guardian by order of a court of competent
jurisdiction; children whose parent or parents have signed an
adoptive surrender; or children for whom the Department has
temporary custody via a voluntary placement agreement.
"Department" means the Illinois Department of Children and
Family Services.
"Director" means the Director of the Illinois Department of
Children and Family Services.
"Emergency" means the existence of circumstances in which a
child for whom the Department has legal responsibility poses a
threat of imminent, serious harm to self or others.
"IDOC" means the Illinois Department of Corrections.
"Pharmacological Review Committee" or "Committee" means a
committee appointed by the Department that is comprised of at
least 3 representatives, at least one of whom is a Board
certified psychiatrist who specializes in the treatment of

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

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

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

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

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

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

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

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

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

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

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

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

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

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