Current through Register Vol. 39, No. 6, September 16, 2024
(a) This Rule
applies to mental retardation centers. All other state facilities shall comply
with Rule .0403 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.
(d) Medication Refusal Incident Defined.
(1) A medication refusal incident is defined
as any behavior on the part of the client, be it verbal or non-verbal, or
legally responsible person, which is judged to be an attempt to communicate an
unwillingness to have psychotropic medication administered to the
client.
(2) Given the
characteristics of the mentally retarded population, some very
commonplace acts that may not necessarily constitute refusal should be
considered. These may include:
(A) passivity
or the lack of active participation in various activities which may require
physical prompting such as hand over hand manipulation in order to learn a
particular skill or complete a particular task;
(B) spitting out medication because of
objectionable texture or taste (Therefore, disguising the texture or taste of
psychotropic medication with a pleasant tasting vehicle such as
applesauce or pudding may not necessarily be considered administration against
the client's will.); or
(C)
tantrums, self-injurious behavior, aggressive acts, etc. which would not
automatically be judged to represent a client's attempt to refuse medication.
However, it is recognized these behaviors in some cases may indeed be the only
form of communication a client may have with which to express his or her
refusal.
(e)
Administration of Medication in Non-Emergency Situations. When a minor or adult
client or his legally responsible person refuses psychotropic medication in a
situation that is not an emergency, the following procedures are required:
(1) If a state facility employee suspects
that a client may be attempting to refuse psychotropic medication, the state
facility employee shall notify the client's qualified mental retardation
professional (QMRP) and the client's internal advocate.
(2) If the QMRP agrees that the client may be
attempting to refuse psychotropic medication, the QMRP shall notify the
client's internal advocate and shall assemble the client's treatment team,
including the treating physician, to assess the refusal incident.
(A) In the case of a client who is suspected
of refusing, the team shall make a decision as to whether the client's
behaviors, be they verbal or non-verbal, are true indications of refusal. In
those instances where behavior is determined not to be refusal, authorization
for the continued administration of the psychotropic medication may be
given.
(B) In those cases where
behaviors are judged to be refusal or when refusal originates with the
competent adult client or with the client's legally responsible person, the
client when possible or appropriate and the legally responsible person shall be
invited to meet with the team to resolve the issue.
(C) The physician shall explain the reasons
for prescribing the medication, the benefits and risks of taking the
medication and the advantages and disadvantages of alternate courses of action.
The team shall make every effort to develop a habilitation plan or specific
form of treatment that would be agreeable to the client or his legally
responsible person and still be consistent with the treatment needs of the
client.
(3) In those
cases where an agreement cannot be reached between the treatment team,
including the physician, and the legally responsible person, and the team,
including the physician, still feels that psychotropic medication
administration is in the best interest of the client, the issue shall be
referred to the State Facility Review Committee appointed by the State Facility
Director.
(A) The composition of this
committee should include a complement of professionals, including the Medical
Director (or his designated physician) and Human Rights Committee
representatives. The internal client advocate shall be invited to represent the
client's interest but not be considered a member of the State Facility Review
Committee. The Committee should not include state facility employees providing
direct services to the client refusing the psychotropic medication. In any
event, the confidentiality regulations as codified in
10A NCAC
26B shall be followed.
(B) As with the treatment team, the State
Facility Review Committee shall involve the client and the legally responsible
person where appropriate in an attempt to arrive at a mutually acceptable
solution.
(C) If agreement is
reached between the legally responsible person and the State Facility Review
Committee, no further proceedings are necessary. If agreement cannot be reached
the State Facility Review Committee shall forward its recommendations
concerning any changes in treatment or support of existing treatment methods to
the Center Director.
(4)
If the State Facility Director receives recommendations concerning any changes
in treatment or support of existing treatment methods regarding a specific
client who has refused psychotropic medications and this recommendation is
still unacceptable to the legally responsible person, the Center Director shall
have, as the last alternative, the authority to discharge the client under
G.S.
122C-57(d). In those cases
where the Center Director makes the decision to discharge the client,
information shall be provided to the legally responsible person regarding the
grievance procedures as specified in
10A NCAC
26B .0203,
26B .0204, and .0205.
(f) Documentation. Each step of
the procedure outlined in Paragraphs (d) through (e) of this Rule shall be
documented in the client record.
(g) 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;
122C-242;
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.
