Utah Administrative Code
Topic - Human Services
Title R523 - Substance Abuse and Mental Health
Rule R523-8 - Medication, Psychosurgery and Electroshock Procedures for Children, Consumer Rights, Due Process, Family Involvement
Section R523-8-5 - Psychosurgery and Electroshock Therapy Procedures for Children, Legal Authority
Universal Citation: UT Admin Code R 523-8-5
Current through Bulletin 2024-06, March 15, 2024
(1) By this rule, the Division establishes the following due process procedure for children prior to their being administered psychosurgery or electroshock therapy.
(a) This policy applies to persons under the
age of 18 who are committed to the physical custody of a local mental health
authority or committed to the legal custody of the Division. The following
terms are herein defined:
(b) "ECT"
means electroconvulsive therapy.
(c) "Psychosurgery" means a neurosurgical
intervention to modify the brain to reduce the symptoms of a severely ill
psychiatric patient.
(d) A local
mental health authority has the obligation to provide a child and guardian with
the following information when recommending that the child be treated with ECT
or Psychosurgery:
(i) The nature of the
child's mental illness;
(ii) The
recommended ECT/Psychosurgery treatment, its purpose, the method of
administration, and recommended length of time for treatment;
(iii) The desired beneficial effects on the
child's mental illness as a result of the recommended treatment;
(iv) The possible or probable mental health
consequences to the child if recommended treatment is not
administered;
(v) The possible side
effects, if any, of the recommended treatment;
(vi) The ability of the staff to recognize
any side effects, should any actually occur, and the possibility of
ameliorating or abating those side effects;
(vii) The possible, if any, alternative
treatments available and whether those treatments are advisable;
(viii) The right to give or withhold consent
for the proposed ECT/psychosurgery; and
(ix) When informing a child and their
guardian they have the right to withhold consent, the local mental health
authority shall inform them that regardless of whether they give or withhold
consent, a due process procedure will be conducted before two Neutral and
Detached Fact Finders to determine the appropriateness of such
treatment.
(e) The child
and guardian shall then be afforded an opportunity to sign a consent form
stating that they have received the information listed in Subsection
R523-8-5(1)(d) of this section, and that they consent or do not consent to the
proposed treatment.
(f) If the
guardian refuses to consent to ECT/psychosurgery, the local mental health
authority shall consider a treatment team dispositional review to determine
whether the child is appropriate for treatment through their
services.
(g) Regardless of whether
the child or guardian agrees or disagrees with the proposed ECT/psychosurgery,
a due process procedure shall be conducted before the treatment can be
administered.
(h) A physician shall
request ECT or psychosurgery for a child by completing a Request to Treat With
ECT or Psychosurgery form and submitting to the Director/Designee of the Local
Mental Health Authority providing treatment.
(i) Upon receipt of the request, the
Director/Designee shall contact two Neutral and Detached Fact Finders, one of
which must be a physician, and set a date and time for an ECT/Psychosurgery
Hearing.
(j) The child and guardian
shall be provided notice of the hearing.
(k) Prior to the hearing, the two designated
examiners shall be provided documentation regarding the child's mental
condition, including the child's medical records, physician's orders,
diagnosis, nursing notes, and any other pertinent information. The attending
physician shall document their proposed course of treatment and reason(s)
justifying the proposal in the medical record.
(l) ECT/psychosurgery hearings shall be
conducted by two Designated Examiners, one of whom is a physician, Hearings
shall be held where the child is currently being treated, and shall be
conducted in an informal, non-adversarial manner as to not have a harmful
effect upon the child.
(i) The child has the
right to attend the hearing, have an adult informant (guardian /foster parent,
etc.) present, and to ask pertinent questions.
(ii) If the child or others become disruptive
during the hearing, the two Neutral and Detached Fact Finders may request that
those persons be removed. The hearing shall continue in that person's absence.
(iii) The hearing shall begin with
the child, guardian, and any others being informed of the purpose and procedure
of the hearing.
(iv) The record
shall be reviewed by the Neutral and Detached Fact Finders and the proposed
treatment shall be discussed.
(v)
The child, guardian, and others present shall be afforded an opportunity to
comment on the issue of ECT or psychosurgery.
(vi) Following the review of the case and the
hearing of comments, the two Neutral and Detached Fact Finders shall render a
decision
(vii) If needed the two
Neutral and Detached Fact Finders may ask everyone to leave the room to allow
them time to deliberate.
(m) The Designated Examiners may order ECT or
psychosurgery if, after consideration of the record and deliberation, they both
find that the following conditions exist:
(i)
The child has a mental illness as defined in the current edition of the
Diagnostic and Statistical Manual of the American Psychiatric Association
(DSM); and
(ii) The child is
gravely disabled and in need of ECT or Psychosurgery for the reason that he/she
suffers from a mental illness such that they (a) are in danger of serious
physical harm resulting from a failure to provide for his essential human needs
of health or safety, or (b) manifests severe deterioration in routine
functioning evidenced by repeated and escalating loss of cognitive or
volitional control over their actions and is not receiving such care as is
essential for their health safety; and/or
(iii) Without ECT or psychosurgery, the child
poses a likelihood of serious harm to self, others, or property. Likelihood of
serious harm means either:
(A) substantial
risk that physical harm will be inflicted by an individual upon their own
person, as evidenced by threats or attempts to commit suicide or inflict
physical harm on one's own self, or
(B) a substantial risk that physical harm
will be inflicted by an individual upon another, as evidenced by behavior which
has caused such harm or which has placed another person or persons in
reasonable fear of sustaining such harm, or
(C) a substantial risk that physical harm
will be inflicted by an individual upon the property of others, as evidenced by
behavior which has caused substantial loss or damage to the property of others;
and
(iv) The proposed
treatment is an appropriate and accepted method of treatment for the patient's
mental condition; and
(v) The
proposed medication treatment is in accordance with prevailing standards of
accepted medical practice.
(n) The basis for the decision shall be
supported by adequate documentation. The Neutral and Detached Fact Finders
shall complete and sign an ECT or Psychosurgery form at the end of the hearing.
A copy of the decision shall be provided to the child and/or
guardian.
(o) The child and/or
guardian may request a second opinion of a decision to treat with ECT or
psychosurgery by filing a Request for a Second Opinion form with the
Director/designee of the Division within 24 hours (excluding Saturdays,
Sundays, and legal holidays) of the initial hearing.
(p) ECT or psychosurgery may be commenced
within 48 hours of the decision by the Neutral and Detached Fact Finders, if no
request for a second opinion is made. If a request is made, treatment may be
commenced as soon as the Director/designee physician renders their affirmative
decision.
(q) Upon receipt of a
Request, the Director/designee will review the record, consult with whomever
he/she believes is necessary, and render a decision within 48 hours (excluding
Saturdays, Sundays, and legal holidays) of receipt of the Request. The
Director/designee shall sign a Second Opinion for Decision to Treat with
ECT/Psychosurgery form which is placed in the child's record. A copy shall be
provided to the child and the guardian prior to the commencement of
treatment.
(r) If a child has been
receiving ECT treatment and requires further treatment than that outlined in
the original ECT plan, the procedures set forth in R523-8-5(1)(d) through (q)
shall be followed before initiating further treatment.
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