Psychiatric Evaluation and Treatment, 40229-40233 [2011-17160]
Download as PDF
<![CDATA[
Federal Register / Vol. 76, No. 131 / Friday, July 8, 2011 / Rules and Regulations
§§ 240.12a–10T and 240.12h–1
eligible to meet the requirements of
these exemptions is a small entity.
[Amended]
5. In § 240.12a–10T(b), remove the
words ‘‘July 16, 2011’’ and add, in their
place, the words ‘‘April 16, 2012’’.
■ 6. In § 240.12h–1(h)T, in the last
sentence, remove the words ‘‘July 16,
2011’’ and add, in their place, the words
‘‘April 16, 2012’’.
■
VIII. Statutory Authority and Text of
the Rules and Amendments
The amendments described in this
release are being adopted under the
authority set forth in Sections 18, 19
and 28 of the Securities Act; Sections
12(h), 23(a) and 36 of the Exchange Act;
and Section 304(d) of the TIA.
List of Subjects in 17 CFR Parts 230,
240 and 260
PART 260—GENERAL RULES AND
REGULATIONS, TRUST INDENTURE
ACT OF 1939
7. The authority citation for part 260
continues to read as follows:
■
Reporting and recordkeeping
requirements, Securities.
Authority: 15 U.S.C. 77eee, 77ggg, 77nnn,
77sss, 78ll(d), 80b–3, 80b–4, and 80b–11.
Text of the Rules and Amendments
*
We are temporarily amending 17 CFR
parts 230, 240, and 260 as follows and
the expiration dates in the temporary
rules and amendments published
January 22, 2009 (74 FR 3967), extended
in a release published on September 17,
2009 (74 FR 47719), and further
extended in a release published on
November 26, 2010 (75 FR 72660), are
further extended from July 16, 2011 to
April 16, 2012.
PART 230—GENERAL RULES AND
REGULATIONS, SECURITIES ACT OF
1933
1. The authority citation for part 230
continues to read, in part, as follows:
*
*
§ 260.4d–11T
*
*
[Amended]
8. In § 260.4d–11T, in the last
sentence, remove the words ‘‘July 16,
2011’’ and add, in their place, the words
‘‘April 16, 2012’’.
■
[FR Doc. 2011–17132 Filed 7–7–11; 8:45 am]
§§ 230.146 and 230.239T
[Amended]
2. In § 230.146(c)T, in the last
sentence, remove the words ‘‘July 16,
2011’’ and add, in their place, the words
‘‘April 16, 2012’’.
■
3. In § 230.239T(e), remove the words
‘‘July 16, 2011’’ and add, in their place,
the words ‘‘April 16, 2012’’.
■
PART 240—GENERAL RULES AND
REGULATIONS, SECURITIES
EXCHANGE ACT OF 1934
4. The authority citation for part 240
continues to read, in part, as follows:
wreier-aviles on DSKGBLS3C1PROD with RULES
■
15:25 Jul 07, 2011
Jkt 223001
[Amended]
2. In paragraph (b)(2) of § 520.2045,
remove ‘‘051311’’ and in its place add
‘‘061623’’.
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Dated: July 1, 2011.
Elizabeth Rettie,
Deputy Director, Office of New Animal Drug
Evaluation, Center for Veterinary Medicine.
[FR Doc. 2011–17151 Filed 7–7–11; 8:45 am]
21 CFR Part 520
BILLING CODE 4160–01–P
[Docket No. FDA–2011–N–0003]
AGENCY:
Food and Drug Administration,
HHS.
ACTION:
Bureau of Prisons
[BOP–1088–F]
The Food and Drug
Administration (FDA) is amending the
animal drug regulations to reflect a
change of sponsor for a new animal drug
application (NADA) from Virbac AH,
Inc., to Cross Vetpharm Group Ltd.
DATES: This rule is effective July 8,
2011.
SUMMARY:
FOR FURTHER INFORMATION CONTACT:
PO 00000
DEPARTMENT OF JUSTICE
28 CFR Part 549
Final rule.
Steven D. Vaughn, Center for Veterinary
Medicine (HFV–100), Food and Drug
Authority: 15 U.S.C. 77c, 77d, 77g, 77j,
Administration, 7520 Standish Pl.,
77s, 77z–2, 77z–3, 77eee, 77ggg, 77nnn,
Rockville, MD 20855, 240–276–8300, e77sss, 77ttt, 78c, 78d, 78e, 78f, 78g, 78i, 78j,
mail: steven.vaughn@fda.hhs.gov.
78j–1, 78k, 78k–1, 78l, 78m, 78n, 78o, 78o–
SUPPLEMENTARY INFORMATION: Virbac
4, 78p, 78q, 78s, 78u–5, 78w, 78x, 78ll,
78mm, 80a–20, 80a–23, 80a–29, 80a–37, 80b– AH, Inc., 3200 Meacham Blvd., Ft.
Worth, TX 76137, has informed FDA
3, 80b–4, 80b–11, and 7201 et seq.; and 18
U.S.C. 1350; and 12 U.S.C. 5221(e)(3) unless
that it has transferred ownership of, and
otherwise noted.
all rights and interest in, NADA 092–
150 for Purina Horse & Colt Wormer
*
*
*
*
*
VerDate Mar<15>2010
§ 520.2045
■
BILLING CODE 8011–01–P
Oral Dosage Form New Animal Drugs;
Change of Sponsor
*
PART 520—ORAL DOSAGE FORM
NEW ANIMAL DRUGS
Authority: 21 U.S.C. 360b.
*
*
List of Subjects in 21 CFR Part 520
Animal drugs.
Therefore, under the Federal Food,
Drug, and Cosmetic Act and under
authority delegated to the Commissioner
of Food and Drugs and redelegated to
the Center for Veterinary Medicine, 21
CFR part 520 is amended as follows:
1. The authority citation for 21 CFR
part 520 continues to read as follows:
Food and Drug Administration
*
(pyrantel tartrate) to Cross Vetpharm
Group Ltd., Broomhill Rd., Tallaght,
Dublin 24, Ireland. Accordingly, the
regulations are amended in 21 CFR
520.2045 to reflect the transfer of
ownership.
This rule does not meet the definition
of ‘‘rule’’ in 5 U.S.C. 804(3)(A) because
it is a rule of ‘‘particular applicability.’’
Therefore, it is not subject to the
congressional review requirements in 5
U.S.C. 801–808.
■
By the Commission.
Dated: July 1, 2011.
Elizabeth M. Murphy,
Secretary.
Authority: 15 U.S.C. 77b, 77c, 77d, 77f,
77g, 77h, 77j, 77r, 77s, 77z–3, 77sss, 78c, 78d,
78j, 78l, 78m, 78n, 78o, 78t, 78w, 78ll(d),
78mm, 80a–8, 80a–24, 80a–28, 80a–29, 80a–
30, and 80a–37, unless otherwise noted.
*
40229
Frm 00013
Fmt 4700
Sfmt 4700
RIN 1120–AB20
Psychiatric Evaluation and Treatment
Bureau of Prisons, Justice.
Final rule.
AGENCY:
ACTION:
In this document, the Bureau
of Prisons (Bureau) finalizes regulations
on providing psychiatric treatment and
medication to inmates. These revised
regulations are clarified and updated to
reflect current caselaw.
DATES: This rule is effective on August
12, 2011.
FOR FURTHER INFORMATION CONTACT:
Sarah Qureshi, Office of General
Counsel, Bureau of Prisons, phone (202)
307–2105.
SUPPLEMENTARY INFORMATION: The
Bureau finalizes regulations on
SUMMARY:
E:\FR\FM\08JYR1.SGM
08JYR1
wreier-aviles on DSKGBLS3C1PROD with RULES
40230
Federal Register / Vol. 76, No. 131 / Friday, July 8, 2011 / Rules and Regulations
providing psychiatric treatment and
medication to inmates. We first
published a proposed regulation
document on this subject in the Federal
Register on December 29, 2003 (68 FR
74892). We then withdrew that
proposed regulation document and
proposed revised regulations on June
16, 2008 (73 FR 33957). We received
four comments, which we address
below.
Two commenters addressed
§ 549.45(b) of the proposed regulation,
which states that, ‘‘[p]ursuant to 18
U.S.C. § 4042, the Bureau is authorized
to provide for the safekeeping, care, and
subsistence, of all persons charged with
offenses against the United States, or
held as witnesses or otherwise.
Accordingly, if an examiner determines
pursuant to § 549.43 of this subpart that
an inmate not subject to hospitalization
pursuant to 18 U.S.C. Chapter 313
should be hospitalized for psychiatric
care or treatment, and the inmate is
unwilling or unable to consent, the
Bureau will provide the inmate with an
administrative hearing to determine
whether hospitalization for psychiatric
care or treatment is warranted. The
hearing will comply with the applicable
procedural safeguards set forth in
§ 549.46(a).’’
The commenters believe that ‘‘the
administrative hearing process’’ under
this section ‘‘is a standard that provides
less procedural protection to the inmate
than does a court determination.’’ The
commenters felt that ‘‘such a standard is
unreasonable and unfair to the inmates
covered by § 549.45(b)’’ because these
inmates may include ‘‘material
witnesses and other detainees who may
not have been convicted,’’ and are,
therefore, ‘‘entitled to a level of review
equal to or surpassing that of sentenced
inmates.’’
In response, we note that proposed
§ 549.45 states that a court
determination is necessary for
involuntary hospitalization or
commitment of inmates pursuant to 18
U.S.C. Chapter 313, who are in need of
psychiatric care or treatment, but are
unwilling or unable to voluntarily
consent. Section 4245 in that chapter
specifically provides for involuntary
hospitalization by court order of a
person serving a sentence of
imprisonment if needed for psychiatric
care or treatment. The necessity of a
court determination for these types of
inmates is, therefore, prescribed by
statute.
In contrast, however, no court
determination is prescribed by statute
with regard to involuntary
hospitalization of inmates who are not
subject to hospitalization under 18
VerDate Mar<15>2010
15:25 Jul 07, 2011
Jkt 223001
U.S.C. 4245 (because not serving a
sentence of imprisonment), such as
alien detainees subject to an order of
deportation, exclusion or removal,
material witnesses, contempt of court
commitments, etc.
Nevertheless, the Director has chosen
to provide administrative due process
with regard to involuntary
hospitalization of such inmates,
‘‘[b]ecause prisoners facing involuntary
transfer to a mental hospital are
threatened with immediate deprivation
of liberty interests they are currently
enjoying, and because of the inherent
risk of a mistaken transfer,’’ adhering to
the principles set forth in Vitek v. Jones,
445 U.S. 480 at 495, 100 S.Ct. 1254 at
1265 (1980).
We note that the availability of this
administrative hearing procedure in
appropriate cases does not limit the
Bureau’s ability to seek judicial
hospitalization or commitment of
inmates under any applicable provision
of Chapter 313, such as judicial
commitment of inmates, whether
sentenced or unsentenced, as sexually
dangerous persons under 18 U.S.C.
4248.
However, because the commenters
appear to question or misunderstand the
due process procedures that the Bureau
implements through this final rule that
specifically apply to the involuntary
hospitalization of inmates who are not
subject to hospitalization under 18
U.S.C. 4245, we alter § 549.45(b) as
follows: We delete the reference to the
due process procedures in § 549.46(a)
and simply restate them, tailored for
reference to involuntary hospitalization
instead of involuntary administration of
psychiatric medication, in the relevant
regulation, § 549.45(b).
Also, the American Psychiatric
Association (APA) and the American
Civil Liberties Union (ACLU)
commented regarding the Bureau’s use
of the phrase ‘qualified health services
staff’ in § 549.44 of the proposed
regulation. The APA recommended that
the Bureau ‘‘clarify this section by either
revising the proposed language in the
regulation or issuing a policy guide
which defines which personnel are
considered ‘qualified health services
staff’ for the purposes of these sections.’’
The ACLU provided a similar comment.
The Bureau will issue a policy guide, as
suggested by the APA, which will
clarify the qualifications for staff with
regard to voluntary hospitalization in a
suitable facility for psychiatric care or
treatment, and voluntary administration
of psychiatric medication. Bureau
policy guides are called Program
Statements, and are designed
specifically to provide more detailed
PO 00000
Frm 00014
Fmt 4700
Sfmt 4700
staff guidance with regard to
implementing Bureau regulations,
policies, and programs. Because
Program Statements are the primary
vehicle for staff guidance, it would be
appropriate to detail health services
staff qualifications in the relevant
Bureau Program Statements.
Also, the APA would ‘‘urge that [the
Bureau] state that only licensed
physicians are qualified to make
decisions about the administration of
psychopharmacologic medications and
that, when possible, a psychiatrist
should be consulted. This clarification
would provide assurance that inmates
are receiving appropriate mental health
treatment and that consent to any
hospitalization or medication is truly
warranted and voluntary and meets
state and Federal law requirements.’’
Likewise, the ACLU commented that
‘‘the regulations should be amended to
clarify that the exception authorizing
more cursory procedures for
emergencies requires that any treatment
be ‘medically’ appropriate, even in an
emergency.’’
In response, we state that Bureau
policy currently requires that
psychiatric medications be prescribed
only by Bureau medical health
professionals that have a permanent,
full, and unrestricted license to practice
medicine in a state, District of
Columbia, the Commonwealth of Puerto
Rico, or a territory of the United States.
Bureau policy on pharmacy services is
predicated on the requirement that the
use of psychiatric medications and
controlled substances be restricted to
physicians only and prescribed only
when medically appropriate. Further, if
an order for psychiatric medication is
prepared or written by a mid-level
practitioner (Physician’s Assistant or
Nurse Practitioner), it must be signed by
a licensed physician before it can be
filled by a pharmacist.
Another commenter suggested that
the Bureau ‘‘recognize psychiatric
advance practice nurses as part of the
treatment team in correctional
facilities.’’ While the Bureau does
utilize nurse practitioners, physician’s
assistants, and nurses, as stated above,
any prescription for psychiatric
medication must be signed by a licensed
physician.
For the aforementioned reasons, we
now finalize the proposed rule
published on June 16, 2008 (73 FR
33957), with minor changes for clarity.
Executive Order 12866
This regulation has been drafted and
reviewed in accordance with Executive
Order 12866, ‘‘Regulatory Planning and
Review’’, section 1(b), Principles of
E:\FR\FM\08JYR1.SGM
08JYR1
Federal Register / Vol. 76, No. 131 / Friday, July 8, 2011 / Rules and Regulations
Regulation. The Director has determined
that this regulation is not a ‘‘significant
regulatory action’’ under Executive
Order 12866, section 3(f), and
accordingly this regulation has not been
reviewed by the Office of Management
and Budget.
Executive Order 13132
This regulation will not have
substantial direct effects on the States,
on the relationship between the national
government and the States, or on
distribution of power and
responsibilities among the various
levels of government. Therefore, under
Executive Order 13132, we determine
that this regulation does not have
sufficient Federalism implications to
warrant the preparation of a Federalism
Assessment.
Regulatory Flexibility Act
Unfunded Mandates Reform Act of
1995
This regulation will not result in the
expenditure by State, local and Tribal
governments, in the aggregate, or by the
private sector, of $100,000,000 or more
in any one year, and it will not
significantly or uniquely affect small
governments. Therefore, no actions were
deemed necessary under the provisions
of the Unfunded Mandates Reform Act
of 1995.
wreier-aviles on DSKGBLS3C1PROD with RULES
Small Business Regulatory Enforcement
Fairness Act of 1996
This regulation is not a major rule as
defined by § 804 of the Small Business
Regulatory Enforcement Fairness Act of
1996. This regulation will not result in
an annual effect on the economy of
$100,000,000 or more; a major increase
in costs or prices; or significant adverse
effects on competition, employment,
investment, productivity, innovation, or
on the ability of United States-based
companies to compete with foreignbased companies in domestic and
export markets.
15:25 Jul 07, 2011
Prisoners.
Thomas R. Kane,
Acting Director, Federal Bureau of Prisons.
Under the rulemaking authority
vested in the Attorney General in 5
U.S.C. 552(a) and delegated to the
Director, Bureau of Prisons, we amend
28 CFR part 549 as follows.
PART 549—MEDICAL SERVICES
1. Revise the authority citation for 28
CFR part 549 to read as follows:
■
Authority: 5 U.S.C. 301; 10 U.S.C. 876b;
18 U.S.C. 3621, 3622, 3524, 4001, 4005, 4042,
4045, 4081, 4082 (Repealed in part as to
offenses committed on or after November 1,
1987), Chapter 313, 5006–5024 (Repealed
October 12, 1984 as to offenses committed
after that date), 5039; 28 U.S.C. 509, 510.
2. Revise subpart C of part 549 to read
as follows:
■
The Director, under the Regulatory
Flexibility Act (5 U.S.C. 605(b)),
reviewed this regulation and by
approving it certifies that it will not
have a significant economic impact
upon a substantial number of small
entities for the following reasons: This
regulation pertains to the correctional
management of offenders committed to
the custody of the Attorney General or
the Director, and its economic impact is
limited to the Bureau’s appropriated
funds.
VerDate Mar<15>2010
List of Subjects in 28 CFR Part 549
Jkt 223001
Subpart C—Psychiatric Evaluation and
Treatment
Sec.
549.40 Purpose and scope.
549.41 Hospitalization in a suitable facility.
549.42 Use of psychiatric medications.
549.43 Transfer for psychiatric or
psychological examination.
549.44 Voluntary hospitalization in a
suitable facility for psychiatric care or
treatment and voluntary administration
of psychiatric medication.
549.45 Involuntary hospitalization in a
suitable facility for psychiatric care or
treatment.
549.46 Procedures for involuntary
administration of psychiatric
medication.
Subpart C—Psychiatric Evaluation and
Treatment
§ 549.40
Purpose and scope.
(a) This subpart describes procedures
for voluntary and involuntary
psychiatric evaluation, hospitalization,
care, and treatment, in a suitable
facility, for persons in Bureau of Prisons
(Bureau) custody. These procedures are
authorized by 18 U.S.C. Chapter 313
and 18 U.S.C. 4042.
(b) This subpart applies to inmates in
Bureau custody, as defined in 28 CFR
part 500.
§ 549.41
facility.
Hospitalization in a suitable
As used in 18 U.S.C. Chapter 313 and
this subpart, ‘‘hospitalization in a
suitable facility’’ includes the Bureau’s
designation of inmates to medical
referral centers or correctional
institutions that provide the required
care or treatment.
PO 00000
Frm 00015
Fmt 4700
Sfmt 4700
§ 549.42
40231
Use of psychiatric medications.
Psychiatric medications will be used
only for treatment of diagnosable mental
illnesses and disorders, and their
symptoms, for which such medication is
accepted treatment. Psychiatric
medication will be administered only
after following the applicable
procedures in this subpart.
§ 549.43 Transfer for psychiatric or
psychological examination.
The Bureau may transfer an inmate to
a suitable facility for psychiatric or
psychological examination to determine
whether hospitalization in a suitable
facility for psychiatric care or treatment
is needed.
§ 549.44 Voluntary hospitalization in a
suitable facility for psychiatric care or
treatment, and voluntary administration of
psychiatric medication.
(a) Hospitalization. An inmate may be
hospitalized in a suitable facility for
psychiatric care or treatment after
providing informed and voluntary
consent when, in the professional
medical judgment of qualified health
services staff, such care or treatment is
required and prescribed.
(b) Psychiatric medication. An inmate
may also provide informed and
voluntary consent to the administration
of psychiatric medication that complies
with the requirements of § 549.42 of this
subpart.
(c) Voluntary consent. An inmate’s
ability to provide informed and
voluntary consent for both
hospitalization in a suitable facility for
psychiatric care or treatment, and
administration of psychiatric
medications, will be assessed by
qualified health services staff and
documented in the inmate’s medical
record. Additionally, the inmate must
sign a consent form to accept
hospitalization in a suitable facility for
psychiatric care or treatment and the
administration of psychiatric
medications. These forms will be
maintained in the inmate’s medical
record.
§ 549.45 Involuntary hospitalization in a
suitable facility for psychiatric care or
treatment.
(a) Hospitalization of inmates
pursuant to 18 U.S.C. Chapter 313. A
court determination is necessary for
involuntary hospitalization or
commitment of inmates pursuant to 18
U.S.C. Chapter 313, who are in need of
psychiatric care or treatment, but are
unwilling or unable to voluntarily
consent.
(b) Hospitalization of inmates not
subject to hospitalization pursuant to 18
U.S.C. chapter 313. Pursuant to 18
E:\FR\FM\08JYR1.SGM
08JYR1
wreier-aviles on DSKGBLS3C1PROD with RULES
40232
Federal Register / Vol. 76, No. 131 / Friday, July 8, 2011 / Rules and Regulations
U.S.C. 4042, the Bureau is authorized to
provide for the safekeeping, care, and
subsistence, of all persons charged with
offenses against the United States, or
held as witnesses or otherwise.
Accordingly, if an examiner determines
pursuant to § 549.43 of this subpart that
an inmate not subject to hospitalization
pursuant to 18 U.S.C. chapter 313
should be hospitalized for psychiatric
care or treatment, and the inmate is
unwilling or unable to consent, the
Bureau will provide the inmate with an
administrative hearing to determine
whether hospitalization for psychiatric
care or treatment is warranted. The
hearing will provide the following
procedural safeguards:
(1) The inmate will not be
involuntarily administered psychiatric
medication before the hearing except in
the case of psychiatric emergencies, as
defined in § 549.46(b)(1).
(2) The inmate must be provided 24hours advance written notice of the
date, time, place, and purpose, of the
hearing, including an explanation of the
reasons for the proposal to hospitalize
the inmate for psychiatric care or
treatment.
(3) The inmate must be informed of
the right to appear at the hearing, to
present evidence, to have a staff
representative, to request witnesses, and
to request that witnesses be questioned
by the staff representative or by the
person conducting the hearing. If the
inmate does not request a staff
representative, or requests a staff
representative with insufficient
experience or education, or one who is
not reasonably available, the institution
mental health division administrator
must appoint a qualified staff
representative.
(4) The hearing is to be conducted by
a psychiatrist other than the attending
psychiatrist, and who is not currently
involved in the diagnosis or treatment of
the inmate.
(5) Witnesses should be called if they
are reasonably available and have
information relevant to the inmate’s
mental condition or need for
hospitalization. Witnesses who will
provide only repetitive information
need not be called.
(6) A treating/evaluating psychiatrist/
clinician, who has reviewed the case,
must be present at the hearing and must
present clinical data and background
information relative to the inmate’s
need for hospitalization. Members of the
treating/evaluating team may also be
called as witnesses at the hearing to
provide relevant information.
(7) The psychiatrist conducting the
hearing must determine whether
involuntary hospitalization is necessary
VerDate Mar<15>2010
15:25 Jul 07, 2011
Jkt 223001
because the inmate is presently
suffering from a mental disease or defect
for the treatment of which he is in need
of custody for care or treatment in a
suitable facility.
(8) The psychiatrist must prepare a
written report regarding the initial
decision. The inmate must be promptly
provided a copy of the initial decision
report, and informed that he/she may
appeal it to the institution’s mental
health division administrator. The
inmate’s appeal, which may be
handwritten, must be submitted within
24 hours after receipt of the hearing
officer’s report. Upon request of the
inmate, the staff representative will
assist the inmate in preparing and
submitting the appeal.
(9) If the inmate appeals the initial
decision, hospitalization must not occur
before the administrator issues a
decision on the appeal. The inmate’s
appeal will ordinarily be reviewed by
the administrator or his designee within
24 hours of its submission. The
administrator will review the initial
decision and ensure that the inmate
received all necessary procedural
protections, and that the justification for
hospitalization is appropriate.
(c) Psychiatric medication. Following
an inmate’s involuntary hospitalization
for psychiatric care or treatment as
provided in this section, psychiatric
medication may be involuntarily
administered only after following the
administrative procedures provided in
§ 549.46 of this subpart.
§ 549.46 Procedures for involuntary
administration of psychiatric medication.
Except as provided in paragraph (b) of
this section, the Bureau will follow the
administrative procedures of paragraph
(a) of this section before involuntarily
administering psychiatric medication to
any inmate.
(a) Procedures. When an inmate is
unwilling or unable to provide
voluntary written informed consent for
recommended psychiatric medication,
the inmate will be scheduled for an
administrative hearing. The hearing will
provide the following procedural
safeguards:
(1) Unless an exception exists as
provided in paragraph (b) of this
section, the inmate will not be
involuntarily administered psychiatric
medication before the hearing.
(2) The inmate must be provided 24hours advance written notice of the
date, time, place, and purpose, of the
hearing, including an explanation of the
reasons for the psychiatric medication
proposal.
(3) The inmate must be informed of
the right to appear at the hearing, to
PO 00000
Frm 00016
Fmt 4700
Sfmt 4700
present evidence, to have a staff
representative, to request witnesses, and
to request that witnesses be questioned
by the staff representative or by the
person conducting the hearing. If the
inmate does not request a staff
representative, or requests a staff
representative with insufficient
experience or education, or one who is
not reasonably available, the institution
mental health division administrator
must appoint a qualified staff
representative.
(4) The hearing is to be conducted by
a psychiatrist other than the attending
psychiatrist, and who is not currently
involved in the diagnosis or treatment of
the inmate.
(5) Witnesses should be called if they
are reasonably available and have
information relevant to the inmate’s
mental condition or need for psychiatric
medication. Witnesses who will provide
only repetitive information need not be
called.
(6) A treating/evaluating psychiatrist/
clinician, who has reviewed the case,
must be present at the hearing and must
present clinical data and background
information relative to the inmate’s
need for psychiatric medication.
Members of the treating/evaluating team
may also be called as witnesses at the
hearing to provide relevant information.
(7) The psychiatrist conducting the
hearing must determine whether
involuntary administration of
psychiatric medication is necessary
because, as a result of the mental illness
or disorder, the inmate is dangerous to
self or others, poses a serious threat of
damage to property affecting the
security or orderly running of the
institution, or is gravely disabled
(manifested by extreme deterioration in
personal functioning).
(8) The psychiatrist must prepare a
written report regarding the initial
decision. The inmate must be promptly
provided a copy of the initial decision
report, and informed that he/she may
appeal it to the institution’s mental
health division administrator. The
inmate’s appeal, which may be
handwritten, must be submitted within
24 hours after receipt of the hearing
officer’s report. Upon request of the
inmate, the staff representative will
assist the inmate in preparing and
submitting the appeal.
(9) If the inmate appeals the initial
decision, psychiatric medication must
not be administered before the
administrator issues a decision on the
appeal, unless an exception exists as
provided in paragraph (b) of this
section. The inmate’s appeal will
ordinarily be reviewed by the
administrator or his designee within 24
E:\FR\FM\08JYR1.SGM
08JYR1
Federal Register / Vol. 76, No. 131 / Friday, July 8, 2011 / Rules and Regulations
wreier-aviles on DSKGBLS3C1PROD with RULES
hours of its submission. The
administrator will review the initial
decision and ensure that the inmate
received all necessary procedural
protections, and that the justification for
administering psychiatric medication is
appropriate.
(10) If an inmate was afforded an
administrative hearing which resulted
in the involuntary administration of
psychiatric medication, and the inmate
subsequently consented to the
administration of such medication, and
then later revokes his consent, a followup hearing will be held before resuming
the involuntary administration of
psychiatric medication. All such followup hearings will fully comply with the
procedures outlined in paragraphs (a)(1)
through (10) of this section.
(b) Exceptions. The Bureau may
involuntarily administer psychiatric
medication to inmates in the following
circumstances without following the
procedures outlined in paragraph (a) of
this section:
(1) Psychiatric emergencies.
(i) During a psychiatric emergency,
psychiatric medication may be
administered only when the medication
constitutes an appropriate treatment for
the mental illness or disorder and its
symptoms, and alternatives (e.g.,
seclusion or physical restraint) are not
available or indicated, or would not be
effective. If psychiatric medication is
still recommended after the psychiatric
emergency, and the emergency criteria
no longer exist, it may only be
administered after following the
procedures in §§ 549.44 or 549.46 of this
subpart.
(ii) For purposes of this subpart, a
psychiatric emergency exists when a
person suffering from a mental illness or
disorder creates an immediate threat of:
(A) Bodily harm to self or others;
(B) Serious destruction of property
affecting the security or orderly running
of the institution; or
(C) Extreme deterioration in personal
functioning secondary to the mental
illness or disorder.
(2) Court orders for the purpose of
restoring competency to stand trial.
Absent a psychiatric emergency as
defined above, § 549.46(a) of this
subpart does not apply to the
VerDate Mar<15>2010
16:28 Jul 07, 2011
Jkt 223001
involuntary administration of
psychiatric medication for the sole
purpose of restoring a person’s
competency to stand trial. Only a
Federal court of competent jurisdiction
may order the involuntary
administration of psychiatric
medication for the sole purpose of
restoring a person’s competency to
stand trial.
[FR Doc. 2011–17160 Filed 7–7–11; 8:45 am]
BILLING CODE 4410–05–P
DEPARTMENT OF DEFENSE
Department of the Navy
32 CFR Part 706
Certifications and Exemptions Under
the International Regulations for
Preventing Collisions at Sea, 1972
Department of the Navy, DoD.
Final rule.
AGENCY:
ACTION:
The Department of the Navy
(DoN) is amending its certifications and
exemptions under the International
Regulations for Preventing Collisions at
Sea, 1972 (72 COLREGS), to reflect that
the Deputy Assistant Judge Advocate
General (DAJAG)(Admiralty and
Maritime Law) has determined that USS
PITTSBURGH (SSN 720) is a vessel of
the Navy which, due to its special
construction and purpose, cannot fully
comply with certain provisions of the 72
COLREGS without interfering with its
special function as a naval ship. The
intended effect of this rule is to warn
mariners in waters where 72 COLREGS
apply.
DATES: This rule is effective July 8, 2011
and is applicable beginning June 29,
2011.
SUMMARY:
FOR FURTHER INFORMATION CONTACT:
Lieutenant Jaewon Choi, (Admiralty and
Maritime Law), Office of the Judge
Advocate General, Department of the
Navy, 1322 Patterson Ave., SE., Suite
3000, Washington Navy Yard, DC
20374–5066, telephone 202–685–5040.
SUPPLEMENTARY INFORMATION: Pursuant
to the authority granted in 33 U.S.C.
1605, the DoN amends 32 CFR part 706.
PO 00000
Frm 00017
Fmt 4700
Sfmt 4700
40233
This amendment provides notice that
the DAJAG (Admiralty and Maritime
Law), under authority delegated by the
Secretary of the Navy, has certified that
USS PITTSBURGH (SSN 720) is a vessel
of the Navy which, due to its special
construction and purpose, cannot fully
comply with the following specific
provision of 72 COLREGS without
interfering with its special function as a
naval ship: Rule 21 (a) pertaining to the
centerline position of the masthead
light. The DAJAG (Admiralty and
Maritime Law) has also certified that the
light involved is located in closest
possible compliance with the applicable
72 COLREGS requirements.
Moreover, it has been determined, in
accordance with 32 CFR parts 296 and
701, that publication of this amendment
for public comment prior to adoption is
impracticable, unnecessary, and
contrary to public interest since it is
based on technical findings that the
placement of lights on this vessel in a
manner differently from that prescribed
herein will adversely affect the vessel’s
ability to perform its military functions.
List of Subjects in 32 CFR Part 706
Marine safety, Navigation (water), and
Vessels.
For the reasons set forth in the
preamble, the Navy amends part 706 of
title 32 of the Code of Federal
Regulations as follows:
PART 706—CERTIFICATIONS AND
EXEMPTIONS UNDER THE
INTERNATIONAL REGULATIONS FOR
PREVENTING COLLISIONS AT SEA,
1972
1. The authority citation for part 706
continues to read as follows:
■
Authority: 33 U.S.C. 1605.
2. Section 706.2 is amended in Table
Two by amending, in alpha numerical
order, by vessel number, an entry for
USS PITTSBURGH (SSN 720) to read as
follows:
■
§ 706.2 Certifications of the Secretary of
the Navy under Executive Order 11964 and
33 U.S.C. 1605.
*
E:\FR\FM\08JYR1.SGM
*
08JYR1
*
*
*
]]>Agencies
[Federal Register Volume 76, Number 131 (Friday, July 8, 2011)]
[Rules and Regulations]
[Pages 40229-40233]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2011-17160]
-----------------------------------------------------------------------
DEPARTMENT OF JUSTICE
Bureau of Prisons
28 CFR Part 549
[BOP-1088-F]
RIN 1120-AB20
Psychiatric Evaluation and Treatment
AGENCY: Bureau of Prisons, Justice.
ACTION: Final rule.
-----------------------------------------------------------------------
SUMMARY: In this document, the Bureau of Prisons (Bureau) finalizes
regulations on providing psychiatric treatment and medication to
inmates. These revised regulations are clarified and updated to reflect
current caselaw.
DATES: This rule is effective on August 12, 2011.
FOR FURTHER INFORMATION CONTACT: Sarah Qureshi, Office of General
Counsel, Bureau of Prisons, phone (202) 307-2105.
SUPPLEMENTARY INFORMATION: The Bureau finalizes regulations on
[[Page 40230]]
providing psychiatric treatment and medication to inmates. We first
published a proposed regulation document on this subject in the Federal
Register on December 29, 2003 (68 FR 74892). We then withdrew that
proposed regulation document and proposed revised regulations on June
16, 2008 (73 FR 33957). We received four comments, which we address
below.
Two commenters addressed Sec. 549.45(b) of the proposed
regulation, which states that, ``[p]ursuant to 18 U.S.C. Sec. 4042,
the Bureau is authorized to provide for the safekeeping, care, and
subsistence, of all persons charged with offenses against the United
States, or held as witnesses or otherwise. Accordingly, if an examiner
determines pursuant to Sec. 549.43 of this subpart that an inmate not
subject to hospitalization pursuant to 18 U.S.C. Chapter 313 should be
hospitalized for psychiatric care or treatment, and the inmate is
unwilling or unable to consent, the Bureau will provide the inmate with
an administrative hearing to determine whether hospitalization for
psychiatric care or treatment is warranted. The hearing will comply
with the applicable procedural safeguards set forth in Sec.
549.46(a).''
The commenters believe that ``the administrative hearing process''
under this section ``is a standard that provides less procedural
protection to the inmate than does a court determination.'' The
commenters felt that ``such a standard is unreasonable and unfair to
the inmates covered by Sec. 549.45(b)'' because these inmates may
include ``material witnesses and other detainees who may not have been
convicted,'' and are, therefore, ``entitled to a level of review equal
to or surpassing that of sentenced inmates.''
In response, we note that proposed Sec. 549.45 states that a court
determination is necessary for involuntary hospitalization or
commitment of inmates pursuant to 18 U.S.C. Chapter 313, who are in
need of psychiatric care or treatment, but are unwilling or unable to
voluntarily consent. Section 4245 in that chapter specifically provides
for involuntary hospitalization by court order of a person serving a
sentence of imprisonment if needed for psychiatric care or treatment.
The necessity of a court determination for these types of inmates is,
therefore, prescribed by statute.
In contrast, however, no court determination is prescribed by
statute with regard to involuntary hospitalization of inmates who are
not subject to hospitalization under 18 U.S.C. 4245 (because not
serving a sentence of imprisonment), such as alien detainees subject to
an order of deportation, exclusion or removal, material witnesses,
contempt of court commitments, etc.
Nevertheless, the Director has chosen to provide administrative due
process with regard to involuntary hospitalization of such inmates,
``[b]ecause prisoners facing involuntary transfer to a mental hospital
are threatened with immediate deprivation of liberty interests they are
currently enjoying, and because of the inherent risk of a mistaken
transfer,'' adhering to the principles set forth in Vitek v. Jones, 445
U.S. 480 at 495, 100 S.Ct. 1254 at 1265 (1980).
We note that the availability of this administrative hearing
procedure in appropriate cases does not limit the Bureau's ability to
seek judicial hospitalization or commitment of inmates under any
applicable provision of Chapter 313, such as judicial commitment of
inmates, whether sentenced or unsentenced, as sexually dangerous
persons under 18 U.S.C. 4248.
However, because the commenters appear to question or misunderstand
the due process procedures that the Bureau implements through this
final rule that specifically apply to the involuntary hospitalization
of inmates who are not subject to hospitalization under 18 U.S.C. 4245,
we alter Sec. 549.45(b) as follows: We delete the reference to the due
process procedures in Sec. 549.46(a) and simply restate them, tailored
for reference to involuntary hospitalization instead of involuntary
administration of psychiatric medication, in the relevant regulation,
Sec. 549.45(b).
Also, the American Psychiatric Association (APA) and the American
Civil Liberties Union (ACLU) commented regarding the Bureau's use of
the phrase `qualified health services staff' in Sec. 549.44 of the
proposed regulation. The APA recommended that the Bureau ``clarify this
section by either revising the proposed language in the regulation or
issuing a policy guide which defines which personnel are considered
`qualified health services staff' for the purposes of these sections.''
The ACLU provided a similar comment. The Bureau will issue a policy
guide, as suggested by the APA, which will clarify the qualifications
for staff with regard to voluntary hospitalization in a suitable
facility for psychiatric care or treatment, and voluntary
administration of psychiatric medication. Bureau policy guides are
called Program Statements, and are designed specifically to provide
more detailed staff guidance with regard to implementing Bureau
regulations, policies, and programs. Because Program Statements are the
primary vehicle for staff guidance, it would be appropriate to detail
health services staff qualifications in the relevant Bureau Program
Statements.
Also, the APA would ``urge that [the Bureau] state that only
licensed physicians are qualified to make decisions about the
administration of psychopharmacologic medications and that, when
possible, a psychiatrist should be consulted. This clarification would
provide assurance that inmates are receiving appropriate mental health
treatment and that consent to any hospitalization or medication is
truly warranted and voluntary and meets state and Federal law
requirements.'' Likewise, the ACLU commented that ``the regulations
should be amended to clarify that the exception authorizing more
cursory procedures for emergencies requires that any treatment be
`medically' appropriate, even in an emergency.''
In response, we state that Bureau policy currently requires that
psychiatric medications be prescribed only by Bureau medical health
professionals that have a permanent, full, and unrestricted license to
practice medicine in a state, District of Columbia, the Commonwealth of
Puerto Rico, or a territory of the United States. Bureau policy on
pharmacy services is predicated on the requirement that the use of
psychiatric medications and controlled substances be restricted to
physicians only and prescribed only when medically appropriate.
Further, if an order for psychiatric medication is prepared or written
by a mid-level practitioner (Physician's Assistant or Nurse
Practitioner), it must be signed by a licensed physician before it can
be filled by a pharmacist.
Another commenter suggested that the Bureau ``recognize psychiatric
advance practice nurses as part of the treatment team in correctional
facilities.'' While the Bureau does utilize nurse practitioners,
physician's assistants, and nurses, as stated above, any prescription
for psychiatric medication must be signed by a licensed physician.
For the aforementioned reasons, we now finalize the proposed rule
published on June 16, 2008 (73 FR 33957), with minor changes for
clarity.
Executive Order 12866
This regulation has been drafted and reviewed in accordance with
Executive Order 12866, ``Regulatory Planning and Review'', section
1(b), Principles of
[[Page 40231]]
Regulation. The Director has determined that this regulation is not a
``significant regulatory action'' under Executive Order 12866, section
3(f), and accordingly this regulation has not been reviewed by the
Office of Management and Budget.
Executive Order 13132
This regulation will not have substantial direct effects on the
States, on the relationship between the national government and the
States, or on distribution of power and responsibilities among the
various levels of government. Therefore, under Executive Order 13132,
we determine that this regulation does not have sufficient Federalism
implications to warrant the preparation of a Federalism Assessment.
Regulatory Flexibility Act
The Director, under the Regulatory Flexibility Act (5 U.S.C.
605(b)), reviewed this regulation and by approving it certifies that it
will not have a significant economic impact upon a substantial number
of small entities for the following reasons: This regulation pertains
to the correctional management of offenders committed to the custody of
the Attorney General or the Director, and its economic impact is
limited to the Bureau's appropriated funds.
Unfunded Mandates Reform Act of 1995
This regulation will not result in the expenditure by State, local
and Tribal governments, in the aggregate, or by the private sector, of
$100,000,000 or more in any one year, and it will not significantly or
uniquely affect small governments. Therefore, no actions were deemed
necessary under the provisions of the Unfunded Mandates Reform Act of
1995.
Small Business Regulatory Enforcement Fairness Act of 1996
This regulation is not a major rule as defined by Sec. 804 of the
Small Business Regulatory Enforcement Fairness Act of 1996. This
regulation will not result in an annual effect on the economy of
$100,000,000 or more; a major increase in costs or prices; or
significant adverse effects on competition, employment, investment,
productivity, innovation, or on the ability of United States-based
companies to compete with foreign-based companies in domestic and
export markets.
List of Subjects in 28 CFR Part 549
Prisoners.
Thomas R. Kane,
Acting Director, Federal Bureau of Prisons.
Under the rulemaking authority vested in the Attorney General in 5
U.S.C. 552(a) and delegated to the Director, Bureau of Prisons, we
amend 28 CFR part 549 as follows.
PART 549--MEDICAL SERVICES
0
1. Revise the authority citation for 28 CFR part 549 to read as
follows:
Authority: 5 U.S.C. 301; 10 U.S.C. 876b; 18 U.S.C. 3621, 3622,
3524, 4001, 4005, 4042, 4045, 4081, 4082 (Repealed in part as to
offenses committed on or after November 1, 1987), Chapter 313, 5006-
5024 (Repealed October 12, 1984 as to offenses committed after that
date), 5039; 28 U.S.C. 509, 510.
0
2. Revise subpart C of part 549 to read as follows:
Subpart C--Psychiatric Evaluation and Treatment
Sec.
549.40 Purpose and scope.
549.41 Hospitalization in a suitable facility.
549.42 Use of psychiatric medications.
549.43 Transfer for psychiatric or psychological examination.
549.44 Voluntary hospitalization in a suitable facility for
psychiatric care or treatment and voluntary administration of
psychiatric medication.
549.45 Involuntary hospitalization in a suitable facility for
psychiatric care or treatment.
549.46 Procedures for involuntary administration of psychiatric
medication.
Subpart C--Psychiatric Evaluation and Treatment
Sec. 549.40 Purpose and scope.
(a) This subpart describes procedures for voluntary and involuntary
psychiatric evaluation, hospitalization, care, and treatment, in a
suitable facility, for persons in Bureau of Prisons (Bureau) custody.
These procedures are authorized by 18 U.S.C. Chapter 313 and 18 U.S.C.
4042.
(b) This subpart applies to inmates in Bureau custody, as defined
in 28 CFR part 500.
Sec. 549.41 Hospitalization in a suitable facility.
As used in 18 U.S.C. Chapter 313 and this subpart,
``hospitalization in a suitable facility'' includes the Bureau's
designation of inmates to medical referral centers or correctional
institutions that provide the required care or treatment.
Sec. 549.42 Use of psychiatric medications.
Psychiatric medications will be used only for treatment of
diagnosable mental illnesses and disorders, and their symptoms, for
which such medication is accepted treatment. Psychiatric medication
will be administered only after following the applicable procedures in
this subpart.
Sec. 549.43 Transfer for psychiatric or psychological examination.
The Bureau may transfer an inmate to a suitable facility for
psychiatric or psychological examination to determine whether
hospitalization in a suitable facility for psychiatric care or
treatment is needed.
Sec. 549.44 Voluntary hospitalization in a suitable facility for
psychiatric care or treatment, and voluntary administration of
psychiatric medication.
(a) Hospitalization. An inmate may be hospitalized in a suitable
facility for psychiatric care or treatment after providing informed and
voluntary consent when, in the professional medical judgment of
qualified health services staff, such care or treatment is required and
prescribed.
(b) Psychiatric medication. An inmate may also provide informed and
voluntary consent to the administration of psychiatric medication that
complies with the requirements of Sec. 549.42 of this subpart.
(c) Voluntary consent. An inmate's ability to provide informed and
voluntary consent for both hospitalization in a suitable facility for
psychiatric care or treatment, and administration of psychiatric
medications, will be assessed by qualified health services staff and
documented in the inmate's medical record. Additionally, the inmate
must sign a consent form to accept hospitalization in a suitable
facility for psychiatric care or treatment and the administration of
psychiatric medications. These forms will be maintained in the inmate's
medical record.
Sec. 549.45 Involuntary hospitalization in a suitable facility for
psychiatric care or treatment.
(a) Hospitalization of inmates pursuant to 18 U.S.C. Chapter 313. A
court determination is necessary for involuntary hospitalization or
commitment of inmates pursuant to 18 U.S.C. Chapter 313, who are in
need of psychiatric care or treatment, but are unwilling or unable to
voluntarily consent.
(b) Hospitalization of inmates not subject to hospitalization
pursuant to 18 U.S.C. chapter 313. Pursuant to 18
[[Page 40232]]
U.S.C. 4042, the Bureau is authorized to provide for the safekeeping,
care, and subsistence, of all persons charged with offenses against the
United States, or held as witnesses or otherwise. Accordingly, if an
examiner determines pursuant to Sec. 549.43 of this subpart that an
inmate not subject to hospitalization pursuant to 18 U.S.C. chapter 313
should be hospitalized for psychiatric care or treatment, and the
inmate is unwilling or unable to consent, the Bureau will provide the
inmate with an administrative hearing to determine whether
hospitalization for psychiatric care or treatment is warranted. The
hearing will provide the following procedural safeguards:
(1) The inmate will not be involuntarily administered psychiatric
medication before the hearing except in the case of psychiatric
emergencies, as defined in Sec. 549.46(b)(1).
(2) The inmate must be provided 24-hours advance written notice of
the date, time, place, and purpose, of the hearing, including an
explanation of the reasons for the proposal to hospitalize the inmate
for psychiatric care or treatment.
(3) The inmate must be informed of the right to appear at the
hearing, to present evidence, to have a staff representative, to
request witnesses, and to request that witnesses be questioned by the
staff representative or by the person conducting the hearing. If the
inmate does not request a staff representative, or requests a staff
representative with insufficient experience or education, or one who is
not reasonably available, the institution mental health division
administrator must appoint a qualified staff representative.
(4) The hearing is to be conducted by a psychiatrist other than the
attending psychiatrist, and who is not currently involved in the
diagnosis or treatment of the inmate.
(5) Witnesses should be called if they are reasonably available and
have information relevant to the inmate's mental condition or need for
hospitalization. Witnesses who will provide only repetitive information
need not be called.
(6) A treating/evaluating psychiatrist/clinician, who has reviewed
the case, must be present at the hearing and must present clinical data
and background information relative to the inmate's need for
hospitalization. Members of the treating/evaluating team may also be
called as witnesses at the hearing to provide relevant information.
(7) The psychiatrist conducting the hearing must determine whether
involuntary hospitalization is necessary because the inmate is
presently suffering from a mental disease or defect for the treatment
of which he is in need of custody for care or treatment in a suitable
facility.
(8) The psychiatrist must prepare a written report regarding the
initial decision. The inmate must be promptly provided a copy of the
initial decision report, and informed that he/she may appeal it to the
institution's mental health division administrator. The inmate's
appeal, which may be handwritten, must be submitted within 24 hours
after receipt of the hearing officer's report. Upon request of the
inmate, the staff representative will assist the inmate in preparing
and submitting the appeal.
(9) If the inmate appeals the initial decision, hospitalization
must not occur before the administrator issues a decision on the
appeal. The inmate's appeal will ordinarily be reviewed by the
administrator or his designee within 24 hours of its submission. The
administrator will review the initial decision and ensure that the
inmate received all necessary procedural protections, and that the
justification for hospitalization is appropriate.
(c) Psychiatric medication. Following an inmate's involuntary
hospitalization for psychiatric care or treatment as provided in this
section, psychiatric medication may be involuntarily administered only
after following the administrative procedures provided in Sec. 549.46
of this subpart.
Sec. 549.46 Procedures for involuntary administration of psychiatric
medication.
Except as provided in paragraph (b) of this section, the Bureau
will follow the administrative procedures of paragraph (a) of this
section before involuntarily administering psychiatric medication to
any inmate.
(a) Procedures. When an inmate is unwilling or unable to provide
voluntary written informed consent for recommended psychiatric
medication, the inmate will be scheduled for an administrative hearing.
The hearing will provide the following procedural safeguards:
(1) Unless an exception exists as provided in paragraph (b) of this
section, the inmate will not be involuntarily administered psychiatric
medication before the hearing.
(2) The inmate must be provided 24-hours advance written notice of
the date, time, place, and purpose, of the hearing, including an
explanation of the reasons for the psychiatric medication proposal.
(3) The inmate must be informed of the right to appear at the
hearing, to present evidence, to have a staff representative, to
request witnesses, and to request that witnesses be questioned by the
staff representative or by the person conducting the hearing. If the
inmate does not request a staff representative, or requests a staff
representative with insufficient experience or education, or one who is
not reasonably available, the institution mental health division
administrator must appoint a qualified staff representative.
(4) The hearing is to be conducted by a psychiatrist other than the
attending psychiatrist, and who is not currently involved in the
diagnosis or treatment of the inmate.
(5) Witnesses should be called if they are reasonably available and
have information relevant to the inmate's mental condition or need for
psychiatric medication. Witnesses who will provide only repetitive
information need not be called.
(6) A treating/evaluating psychiatrist/clinician, who has reviewed
the case, must be present at the hearing and must present clinical data
and background information relative to the inmate's need for
psychiatric medication. Members of the treating/evaluating team may
also be called as witnesses at the hearing to provide relevant
information.
(7) The psychiatrist conducting the hearing must determine whether
involuntary administration of psychiatric medication is necessary
because, as a result of the mental illness or disorder, the inmate is
dangerous to self or others, poses a serious threat of damage to
property affecting the security or orderly running of the institution,
or is gravely disabled (manifested by extreme deterioration in personal
functioning).
(8) The psychiatrist must prepare a written report regarding the
initial decision. The inmate must be promptly provided a copy of the
initial decision report, and informed that he/she may appeal it to the
institution's mental health division administrator. The inmate's
appeal, which may be handwritten, must be submitted within 24 hours
after receipt of the hearing officer's report. Upon request of the
inmate, the staff representative will assist the inmate in preparing
and submitting the appeal.
(9) If the inmate appeals the initial decision, psychiatric
medication must not be administered before the administrator issues a
decision on the appeal, unless an exception exists as provided in
paragraph (b) of this section. The inmate's appeal will ordinarily be
reviewed by the administrator or his designee within 24
[[Page 40233]]
hours of its submission. The administrator will review the initial
decision and ensure that the inmate received all necessary procedural
protections, and that the justification for administering psychiatric
medication is appropriate.
(10) If an inmate was afforded an administrative hearing which
resulted in the involuntary administration of psychiatric medication,
and the inmate subsequently consented to the administration of such
medication, and then later revokes his consent, a follow-up hearing
will be held before resuming the involuntary administration of
psychiatric medication. All such follow-up hearings will fully comply
with the procedures outlined in paragraphs (a)(1) through (10) of this
section.
(b) Exceptions. The Bureau may involuntarily administer psychiatric
medication to inmates in the following circumstances without following
the procedures outlined in paragraph (a) of this section:
(1) Psychiatric emergencies.
(i) During a psychiatric emergency, psychiatric medication may be
administered only when the medication constitutes an appropriate
treatment for the mental illness or disorder and its symptoms, and
alternatives (e.g., seclusion or physical restraint) are not available
or indicated, or would not be effective. If psychiatric medication is
still recommended after the psychiatric emergency, and the emergency
criteria no longer exist, it may only be administered after following
the procedures in Sec. Sec. 549.44 or 549.46 of this subpart.
(ii) For purposes of this subpart, a psychiatric emergency exists
when a person suffering from a mental illness or disorder creates an
immediate threat of:
(A) Bodily harm to self or others;
(B) Serious destruction of property affecting the security or
orderly running of the institution; or
(C) Extreme deterioration in personal functioning secondary to the
mental illness or disorder.
(2) Court orders for the purpose of restoring competency to stand
trial. Absent a psychiatric emergency as defined above, Sec. 549.46(a)
of this subpart does not apply to the involuntary administration of
psychiatric medication for the sole purpose of restoring a person's
competency to stand trial. Only a Federal court of competent
jurisdiction may order the involuntary administration of psychiatric
medication for the sole purpose of restoring a person's competency to
stand trial.
[FR Doc. 2011-17160 Filed 7-7-11; 8:45 am]
BILLING CODE 4410-05-P
