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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 J. Zanoni 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. Page 1 of 6 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. Page 2 of 6 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. Page 3 of 6 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. Page 4 of 6 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. Page 5 of 6 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. Page 6 of 6