INVOLUNTARY MEDICATION G-180 FRESNO COUNTY SHERIFF'S OFFICE
JAIL DIVISION POLICIES AND PROCEDURES
TITLE: INVOLUNTARY MEDICATION ADMINISTRATION NO: G-180
FILE: INVOLUNTARY MEDICATION
EFFECTIVE DATE: 08-13-21 REVISED:
AUTHORITY: Sheriff M. Mims APPROVED BY: Assistant Sheriff S. McComas
REFERENCE: California Code of Regulations, Title 15, Sections 1200, 1209, 1214 and
1217; Penal Code sections 1367, 1369.1, 1370 et seq. and 2603; Welfare and
Institutions Code section 5326.2; Hall, et al. v. County of Fresno, 1-1 1-CV-02047-
LJO-BAM (2015); and Fresno County Board of Supervisors Resolution No. 20-032.
PURPOSE:
The purpose of this policy is to delineate the conditions under which psychotropic
medications may be administered involuntarily to inmates.
POLICY:
The Fresno County Sheriff's Office is committed to providing voluntary mental health care
to all inmates and recognizes the right of a legally competent person to make decisions
regarding medication. Any inmate who has not been adjudicated to be incompetent may
refuse non-emergency medical and mental health care. Absent informed consent in non-
emergency situations, a court order is required before involuntary medical treatment can
be administered to an inmate.
The Fresno County Jail has been designated as a "treatment facility" to provide
prescribed medication to defendants who lack the capacity to give informed consent.
Antipsychotic medication may be administered involuntarily on a non-emergency basis
as authorized by court order for inmates found to be mentally incompetent. Prior to the
administration of involuntary psychiatric medication, the Fresno County Jail shall make a
documented attempt to locate an available bed for the inmate in a community-based
treatment facility.
The jail medical provider shall adhere to a policy which limits the length of time both
voluntary and involuntary psychotropic medications may be administered and a plan of
monitoring and re-evaluating all inmates receiving psychotropic medications, including a
review of all emergency situations.
The administration of psychotropic medication shall not be used for disciplinary reasons.
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FRESNO COUNTY SHERIFF'S OFFICE
JAIL DIVISION POLICIES AND PROCEDURES
TITLE: INVOLUNTARY MEDICATION ADMINISTRATION NO: G-180
FILE: INVOLUNTARY MEDICATION
PROCEDURES:
I. AUTHORITY FOR TREATMENT
A. Inmates may receive involuntary medication in an effort to restore
competency or prevent further decompensation of their mental health.
The administration of involuntary medication is only permitted when
authorized by law and court order.
1. Inmates who have been adjudicated incompetent to stand trial and
are unable to provide informed consent to prescribed medication, may
have a court order authorizing the administration of involuntary
medication pursuant to Penal Code sections 1370, 2603, or other
lawful authority.
2. Inmates who have been ordered subject to a conservatorship by the
court may have an order authorizing the conservator, which may be
a named person or the Public Guardian, to give consent for medical
treatment on behalf of the inmate-conservatee.
B. The order shall be valid for no longer than one (1) year and the treatment
period shall not exceed six (6) months.
C. Once the inmate's confinement ends or they no longer meet the criteria
for involuntary medication, the order is no longer valid.
II. RESPONSIBILITIES - PLANNING AND COORDINATION
A. Upon receipt of a court order that authorizes the involuntary
administration of a psychiatric medication, the receiving Jail Records
supervisor shall forward a copy of the order to the Jail Division Bureau
Commanders.
B. The Jail Medical & Services Bureau Commander (or in his/her absence,
the Jail Operations Bureau Commander) will be responsible to:
1. Notify the jail medical provider's Health Services Administrator (HSA)
and provide a copy of the court order.
2. Ensure that a documented attempt is made to locate an available bed
for the inmate in a community-based treatment facility in lieu of
seeking to administer involuntary medication.
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FRESNO COUNTY SHERIFF'S OFFICE
JAIL DIVISION POLICIES AND PROCEDURES
TITLE: INVOLUNTARY MEDICATION ADMINISTRATION NO: G-180
FILE: INVOLUNTARY MEDICATION
3. Ensure that a sergeant is assigned and designated as the Involuntary
Medication Administration Team (IMAT) supervisor.
C. The IMAT Sergeant will participate directly in both the planning and
supervision of the administration of the medication.
1. The sergeant shall attend the multidisciplinary treatment team
meeting and collaborate with health care staff to determine the time,
method, manner, specific location, and terms for involuntary
administration of the prescribed medication. The safety and well-
being of each individual inmate and involved staff will be considered.
The discussion will include any specific medical concerns and sites of
the body intended for the administration of the medication. The plan
will be documented in the treatment team meeting minutes.
2. Psychiatric medication shall not normally be involuntarily
administered to an inmate in his/her housing unit. An inmate shall
normally be transferred to an infirmary room prior to the administration
of the medication. If a psychiatrist determines that the prior transfer
of the inmate to such a setting would pose a greater risk to the inmate
and staff than the risk involved to the inmate in receiving the
medication in a non-medical setting, the medication may be
involuntarily administered in the inmate's cell, or other area
determined to be appropriate. An alternative location may be
determined by the sergeant in consultation with jail medical staff.
D. Medical staff will be responsible to develop a written plan to-
1. Provide a minimum level of ongoing monitoring of the inmate following
return to facility housing. This monitoring may be performed by
custody staff trained to recognize signs of possible medical problems
and alert medical staff when indicated.
2. Monitor the inmate's medical condition following the initial involuntary
administration of a medication, until the inmate is cleared as a result
of an evaluation by, or consultation with, a psychiatrist.
3. Submit a report to the court regarding the progress of the inmate
within ninety (90) days.
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FRESNO COUNTY SHERIFF'S OFFICE
JAIL DIVISION POLICIES AND PROCEDURES
TITLE: INVOLUNTARY MEDICATION ADMINISTRATION NO: G-180
FILE: INVOLUNTARY MEDICATION
III. THE ADMINISTRATION OF INVOLUNTARY MEDICATION
A. Correctional staff shall be present to provide safety and security, but in
no way shall participate in the actual administration of involuntary
medication.
B. The IMAT Sergeant shall be responsible to-
1. Review the court order to confirm it is still valid prior to initiating the
procedure for the involuntary administration of the psychotropic
medication.
2. Notify the affected Facility Sergeant(s) regarding the intent to
administer involuntary medication, as well as the location within the
facility.
3. Brief staff regarding the plan to enter the cell and secure the inmate.
4. Procure a Pro-Straint Restraint Chair, if necessary.
5. Assign an officer to video record the event.
6. Supervise and direct all actions of correctional staff throughout the
involuntary medication administration.
C. The full event and administering of medication shall be video recorded.
All opportunities given to the inmate to comply with orders shall be
recorded. [Refer to policy D-215/Recorded Planned Emergency Responses (FILE:
VIDEO RECORDINGS).]
D. If extracted, the inmate is to be escorted to an appropriate location where
the medication is to be administered. The inmate will be encouraged to
voluntarily ambulate.
1. If the inmate refuses to ambulate and it is safe to do so, correctional
staff may use calculated force to transfer the inmate to the agreed
upon location. A Pro-Straint Restraint chair may be used to transport
the inmate.
2. If the transfer poses a significant danger of harm to the inmate or staff,
then administration can take place without transfer.
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FRESNO COUNTY SHERIFF'S OFFICE
JAIL DIVISION POLICIES AND PROCEDURES
TITLE: INVOLUNTARY MEDICATION ADMINISTRATION NO: G-180
FILE: INVOLUNTARY MEDICATION
E. The inmate shall always be given the opportunity to accept the
medication voluntarily by the administering health services personnel
prior to any involuntary administration. Prior to using any force, the IMAT
Sergeant will encourage the inmate to comply with medical staff and
voluntarily take the medication.
F. If force becomes necessary, officers shall only use that level of force
which is objectively reasonable for the involuntary administration of
psychotropic medication. [Refer also to Section IV/Use of Restraints When
Administering Involuntary Medication.]
G. Once the inmate is secure, medical staff will be permitted to enter the
area and administer the psychiatric medication. Medical and mental
health staff will use clinical judgment when it is safe to administer
medications.
H. An officer shall be assigned to directly observe the inmate for one (1)
hour following the administration of involuntary medication. Medical staff
will monitor the inmate's vital signs in accordance with medical protocol.
The officer will remain present and provide assistance, if necessary.
1. In the event the inmate develops side effects from the medication,
monitoring staff shall notify the designated medical/mental health staff
immediately.
2. If a significant adverse reaction to the medication occurs, emergency
care shall be given and the inmate shall be immediately transferred
to a higher level of care.
I. Correctional staff involved in the administration of involuntary medication
shall complete an incident report documenting their involvement prior to
the end of shift.
IV. USE OF RESTRAINTS WHEN ADMINISTERING INVOLUNTARY
MEDICATION
A. Restraints may be used to protect the safety of the inmate and staff.
Medical staff shall not participate in decisions to initiate use of restraints
by correctional staff.
1. Before applying restraints, staff shall attempt to gain the inmate's
cooperation.
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FRESNO COUNTY SHERIFF'S OFFICE
JAIL DIVISION POLICIES AND PROCEDURES
TITLE: INVOLUNTARY MEDICATION ADMINISTRATION NO: G-180
FILE: INVOLUNTARY MEDICATION
2. No form of restraint which places the inmate in a prone (i.e., face
down) position shall be used.
3. A Pro-Straint Restraint chair may be used to restrain the inmate
during the involuntary administration of medication.
B. The inmate shall be removed from restraints as soon as it is determined
that safety reasons no longer necessitate the use of restraints. Medical
staff shall examine the inmate for injuries immediately after being
released from restraints.
C. The type of restraint used shall be documented in the incident report.
V. EMERGENCY INVOLUNTARY ADMINISTRATION OF MEDICATION
A. Psychotropic medication may be administered involuntarily to an inmate
in emergency circumstances or as otherwise allowed by law and only
with a physician's order.
1. An emergency is a situation in which action to impose treatment over
the inmate's objection is immediately necessary for the preservation
of life or the prevention of serious bodily harm to the inmate or others,
and it is impracticable to first gain consent.
2. The medication administered shall only be what is required to treat
the emergency condition and administered for only as long as the
emergency continues to exist.
B. A court order shall be sought or legal consent shall be obtained if the
responsible physician anticipates further dosage will be necessary or
beneficial.
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