Current through Register Vol. 39, No. 6, September 16, 2024
(a) This
Rule applies to all state facilities with the exception of mental retardation
centers. Mental retardation centers shall comply with Rule .0404 of this
Section.
(b) In the case of an
emergency, procedures specified in Rule .0401 of this Section shall
apply.
(c) In the case of a
client's refusal of psychotropic medication in a non-emergency, the best
interest test as specified in Rule .0402 of this Section shall apply. A court
order issued regarding the administration of medication for forensic patients
would take precedence over this Rule.
(d) Administration to Involuntary Clients.
(1) When an involuntary client or his legally
responsible person refuses psychotropic medication in a situation that is not
an emergency, the following procedures are required:
(A) The attending physician shall speak to
the client or legally responsible person, if applicable, and attempt to explain
his assessment of the client's condition, the reasons for prescribing the
medication, the benefits and risks of taking the medication, and the advantages
and disadvantages of alternative courses of action. If the client or his
legally responsible person still refuses and the physician still believes that
psychotropic medication administration is in the best interest of the client as
specified in Rule .0402 of this Section:
(i)
the physician shall tell the client and the legally responsible person, if
applicable, that the matter will be discussed at a meeting of the client's
treatment team;
(ii) if the
client's clinical condition permits, the physician shall invite the client and
the legally responsible person, if applicable, to attend the meeting of the
treatment team; and
(iii) the
physician shall suggest that the client and the legally responsible person, if
applicable, discuss the matter with a person of his own choosing, such as a
relative, friend, guardian or client advocate.
(B) The treatment team shall meet to review
the client's or legally responsible person's response and assess the need for
psychotropic medication.
(i) If the client or
legally responsible person is present, the treatment team shall attempt to
formulate a treatment or habilitation plan that is acceptable to both the
client or legally responsible person and the treatment team. The client or
legally responsible person may agree to take medication unconditionally or
under certain conditions that are acceptable to the treatment team.
(ii) If the client or legally responsible
person is not present, the treatment team shall review its previous
recommendations and the client's response and shall document their decision in
the client record.
(C)
If, after assessing the need, the treatment team still believes that
psychotropic medication administration is in the best interest of the client as
specified in Rule .0402 of this Section and the client or legally responsible
person still refuses administration of the prescribed medication, the Director
of Clinical Services or his physician designee, who is not a member of the
client's treatment team, shall interview the client and review the record, and
may approve the administration of the medication over the objection of the
client and legally responsible person.
(2) Such refusal shall be documented in the
client record.
(e)
Administration to Voluntary Clients.
(1) When
a voluntary client in a state facility refuses psychotropic medication in a
non-emergency situation, the medication shall not be administered to:
(A) a competent adult client without the
client's consent;
(B) an
incompetent adult client without consent of the legally responsible person;
or
(C) a minor client without the
consent of the legally responsible person.
(2) Such refusal shall be documented in the
client record.
(f)
Independent Psychiatric Evaluation.
(1)
Whenever the Director of Clinical Services is asked to review a psychotropic
medication decision, the Director of Clinical Services may retain an
independent psychiatric consultant to evaluate the client's need for
psychotropic medication. The use of a psychiatric consultant may be
particularly indicated in cases where there is a disagreement between the
prescribing physician and other members of the treatment team.
(2) If the client is evaluated by an
independent psychiatric consultant, the Director of Clinical Services shall
file a report in the client record indicating:
(A) the recommendation of the consultant;
and
(B) why the Director of
Clinical Services made a decision to follow, or not to follow, the consultant's
recommendation.
(g) Case Review by the Director of Clinical
Services.
(1) The Director of Clinical
Services or his physician designee shall review each week the treatment or
habilitation program of each client who is refusing to accept psychotropic
medication administration voluntarily to determine:
(A) whether the client is still receiving the
prescribed medication;
(B) whether
psychotropic medication is still in the best interest of the client as
specified in Rule .0402 of this Section; and
(C) whether the other components of the
client's treatment or habilitation plan are being implemented.
(2) The Director of Clinical
Services (not his designee) shall review quarterly the treatment or
habilitation program of each client who is refusing to accept psychotropic
medication administration voluntarily to determine:
(A) whether the client is still receiving the
prescribed medication;
(B) whether
psychotropic medication is still in the best interest of the client as defined
in Rule .0402 of this Section; and
(C) whether the other components of the
client's treatment or habilitation plan are being implemented.
(h) Documentation.
(1) Each step of the procedures outlined in
Paragraphs (d) through (g) of this Rule shall be documented in the client
record.
(2) Whenever the client or
his legally responsible person has refused the administration of psychotropic
medication and later agrees to such administration, the documentation of
consent, either verbal or written, shall be included in the client
record.
(i) A client's
willingness to accept medications administered by mouth in lieu of accepting
medications administered by an intramuscular route does not necessarily
constitute consent. The responsible professional shall ensure that the client
is indeed willing to accept the medication and is not responding to
coercion.
(j) Statistical Record.
The State Facility Director shall maintain a statistical record of the use of
psychotropic medication against the client's will which shall include, but not
be limited to, the number of administrations by client, unit of like grouping,
responsible physician, and client characteristics. The statistical record shall
be made available to the Division Director and Human Rights Committee on a
monthly basis.
Authority
G.S.
122C-51;
122C-57;
131E-67;
143B-147;
Eff.
October 1, 1984;
Amended Eff. April 1, 1990; July 1,
1989;
Pursuant to
G.S.
150B-21.3A, rule is necessary without
substantive public interest Eff. May 1, 2018.
