HomeMy WebLinkAboutInvoluntary Treatment and MedicationIdaho
Department of
Correction
Standard
Operating
Procedure
Operations
Division
Operational
Services
Control Number:
401.06.03.067
Version:
2.1
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Adopted:
3-1-2001
Reviewed:
8-2-2012 Title:
Involuntary Medication and Treatment
This document was approved by Shane Evans, director of the Education,
Treatment, and Reentry Bureau, on 8/2/12 (signature on file).
Open to the general public: Yes
BOARD OF CORRECTION IDAPA RULE NUMBER 401
Medical Care
POLICY CONTROL NUMBER 401
Clinical Services and Treatment
DEFINITIONS
Standardized Terms and Definitions List
Chief Psychologist: The Idaho Department of Correction (IDOC) employee who is primarily
responsible for overseeing or managing the IDOC’s mental health services.
Diagnostic and Statistical Manual of Mental Disorders (DSM): The standard manual of
psychiatric diagnoses, as published and amended by the American Psychiatric Association
from time to time.
Emergency Involuntary Medication: The administration of medication to an offender
without the offender’s informed consent but only in situations that warrant emergency
intervention and only for a limited duration.
Gravely Disabled: A condition in which a person, as a result of a physical or mental
disorder, (a) is in danger of serious physical harm resulting from a failure to provide his
essential human needs of health or safety; or (b) manifests severe deterioration in routine
functioning as evidenced by repeated and escalating loss of cognitive or volition control over
his actions and is not receiving such care as is essential for his health or safety.
Health Authority: The Idaho Department of Correction (IDOC) employee who is primarily
responsible for overseeing or managing the IDOC’s medical services. (The health authority
is commonly referred to as the health services director.)
Idaho Security Medical Program (ISMP): A statutorily-constituted program maintained by
the Idaho Board of Correction for persons displaying evidence of mental illness or
psychological disorders, requiring diagnosis and treatment in a maximum security setting,
and for other criminal commitments.
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Involuntary Medication: The administration of medication to an offender without the
offender’s informed consent. (Under non-emergency involuntary medication situations, the
administration of medication will occur only after holding an involuntary medication hearing.)
Involuntary Medication Hearing: A hearing to determine whether an offender in a non-
emergency involuntary medication situation should be subject to involuntary medication.
Involuntary Medication Hearing Committee (IMHC): A committee comprised of a deputy
warden, non-treating psychologist, and non-treating psychiatrist for the purpose of
determining whether an offender should be subjected to involuntary medication. (The non-
treating psychiatrist shall serve as chair of the IMHC.)
Involuntary Medication Report: A report, submitted by the treating psychiatrist, requesting
the involuntary medication of an offender who will not or cannot give informed consent to
treatment.
Likelihood of Serious Harm: A substantial risk that:
• Physical harm will be inflicted by an individual upon his own person, as evidenced by
threats or attempts to commit suicide or inflict physical harm on himself; or
• Physical harm will be inflicted by an individual upon another, as evidenced by
behavior which has caused such harm or which places another person or persons in
reasonable fear of sustaining such harm; or
• Harm will be inflicted by an individual upon his or other’s property as evidenced by
behavior which has caused substantial loss or damage to his or other’s property.
Medical Director: A physician either employed by the Idaho Department of Correction
(IDOC) or contracted through privatized services (i.e., the physician in charge if medical
services are privatized).
Mental Disorder: Any organic, mental, or emotional impairment which has a substantial
adverse effect on an individual’s cognitive functioning or volitional control.
Preponderance of the Evidence: The general standard of proof in most civil cases, which
is the degree of proof that will lead a person (e.g., a party, an investigator) to conclude that
the existence of the fact is more probable than not.
Regional Health Manager: The individual (a) assigned as the primary manager, and (b)
administratively responsible for the delivery of medical services, if health services are
privatized.
PURPOSE
The purpose of this standard operating procedure (SOP) is to establish guidelines for the
involuntary administration of medications to those offenders suffering from mental disorders,
who as a result of those disorders, are considered gravely disabled and/or presents the
likelihood of serious harm to self, others, or their property.
SCOPE
This SOP applies to all Idaho Department of Correction (IDOC) employees, offenders,
contract medical providers and subcontractors.
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More specifically in regards to offenders, this SOP applies to those offenders (a) committed
to the custody of the IDOC pursuant to a judgment of conviction, and (b) committed to the
Idaho Security Medical Program pursuant to Idaho Code, section 66-1306 et seq.
RESPONSIBILITY
The director of the Education, Treatment, and Reentry Bureau and deputy chief of the
Prisons Bureau shall be jointly responsible for the implementation of this SOP and for
designating appropriate personnel to develop and implement procedures in conjunction with
this SOP.
Table of Contents
General Requirements ......................................................................................................... 4
1. Right to Refuse Treatment .............................................................................................. 4
2. Informed Consent ........................................................................................................... 4
3. Recording the Administration of Involuntary Medication ................................................. 4
4. Use of Force ................................................................................................................... 4
5. Offender’s Right to Seek Relief ...................................................................................... 4
Emergency Involuntary Medication For Offenders ................................................................ 5
6. Basis and Procedure for Emergency Involuntary Medication .......................................... 5
Treating Physician and Psychiatrist Responsibilities ................................................. 5
Duration of Treatment ............................................................................................... 6
Offender Consent to and then Refuses Treatment .................................................... 6
Non-emergency Involuntary Medication For Offenders ......................................................... 6
7. Basis for Non-emergency Involuntary Medication ........................................................... 6
8. Pre-involuntary Medication Hearing Procedure ............................................................... 7
Treating Physician and Psychiatrist Responsibilities ................................................. 7
24 Hours Prior to Involuntary Medication Hearing: Offender’s Right to Refuse
Treatment ................................................................................................................. 8
Involuntary Medication Hearing Officer Appointment ................................................ 8
Involuntary Medication Hearing Officer Responsibilities ............................................ 8
Staff Hearing Assistant Appointment and Responsibilities ........................................ 8
Notice of Involuntary Medication Hearing .................................................................. 9
Involuntary Medication Hearing Committee (IMHC) Responsibilities ....................... 10
Offender’s Non-participation or Exclusion From the Involuntary Medication Hearing
Process .................................................................................................................. 10
9. Involuntary Medication Hearing Procedure ................................................................... 10
Involuntary Medication Hearing Officer Responsibilities .......................................... 10
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Presentation of Evidence ........................................................................................ 11
IMHC Deliberation .................................................................................................. 12
Involuntary Medication Hearing Record .................................................................. 13
10. Appeal and Automatic Review of IMHC’s Decision ....................................................... 14
11. Periodic Review of the Administration of Non-emergency Involuntary Medication ........ 15
Non-emergency Involuntary Medication For Offenders Deemed Unfit For Criminal Trial .... 15
12. Idaho Security Medical Program (ISMP) ....................................................................... 15
References ......................................................................................................................... 16
GENERAL REQUIREMENTS
1. Right to Refuse Treatment
Pursuant to SOP 401.06.03.071, Right to Refuse Treatment, an offender has the right to
refuse treatment, including medications. The involuntary medication of an offender may only
take place under the circumstances and procedures described herein this SOP.
2. Informed Consent
Prior to any involuntary administration of medication to an offender, an attempt must be
made to obtain the offender’s informed consent (see SOP 401.06.03.070, Informed
Consent). If the offender provides informed consent, treatment will be provided and staff
shall no longer be required to follow the guidance provided herein this SOP.
3. Recording the Administration of Involuntary Medication
The administration of involuntary medication shall be recorded with a video recorder. A copy
of the recording will be retained in the offender’s healthcare record.
4. Use of Force
If the administration of involuntary medication is ordered and the use of force is required,
only the amount of force necessary to administer the medication shall be used.
Note: The use of force must be preceded by an attempt to use a less restrictive means to
administer the medication. When the use of force is required, it shall be in accordance with
SOP 307.02.01.001, Use of Force: Prisons and Reentry Centers (CRCs).
5. Offender’s Right to Seek Relief
Nothing in this SOP shall be construed as limiting or expanding an offender’s rights to seek
relief.
Note: Offenders shall not use the grievance process described in SOP 316.02.01.001,
Grievance and Informal Resolution Procedure for Offenders, to seek relief. Instead,
offenders may seek relief through the courts.
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EMERGENCY INVOLUNTARY MEDICATION FOR OFFENDERS
6. Basis and Procedure for Emergency Involuntary Medication
Generally, an involuntary medication hearing must be held prior to any involuntary
administration of medication to an offender. However, a physician or psychiatrist may order
the emergency involuntary administration of medication without holding an involuntary
medication hearing if, in his professional judgment, the offender:
• Is refusing or is unable to consent to treatment;
• Is suffering from a ‘mental disorder’;
• As a result of that mental disorder, presents an imminent likelihood of serious harm
to self or others, including the failure to care for self if the harm is imminent; and
• Is unlikely to respond to less restrictive medically acceptable alternatives, or such
alternatives are not available or have not been successful.
Note: For the purpose of this SOP only, ‘mental disorder’ includes mental illness or
psychological disorders which may provide a basis for commitment to the Idaho Security
Medical Program pursuant to Idaho Code, section 66-1306 et seq.
Note: The emergency involuntary administration of medication to the offender shall only
occur where there is an existing emergency and shall not be ordered in anticipation of a
potential or future emergency.
Note: No more than two (2) emergencies for a single offender may be declared within any
30-day period.
Physician and Psychiatrist Responsibilities
Where the emergency involuntary administration of medication is ordered by a physician
who is not a psychiatrist, the physician must consult with a psychiatrist within 24 hours of
administering the medication to the offender.
• If the psychiatrist concurs with the physician, treatment may be continued for an
additional 48 hour period.
• If the psychiatrist does not concur, treatment shall cease immediately.
• Documentation of the psychiatrist’s consultation shall be entered in the offender’s
healthcare record.
After the emergency involuntary administration of medication to the offender, the
physician or psychiatrist will:
• Ensure monitoring occurs for adverse reactions and side effects;
• Document in the offender’s healthcare record the specific justification for the
medication, when and how the medication is to be administered, what alternative
treatments were attempted (or if no alternative treatments were attempted,
document why alternative treatments were not attempted, were unavailable, or
were unlikely to succeed); and
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• Notify the facility head (or designee) and the chief psychologist within 24 hours of
initiating treatment and document the notification in the offender’s healthcare
record.
Duration of Treatment
The emergency involuntary administration of medication to the offender shall have a
maximum duration of 72 hours for a single emergency and may not continue beyond
that time without holding an involuntary medication hearing.
If during the 72-hour period the offender consents to treatment, the 72-hour period will
no longer apply. The offender’s consent to treatment shall be documented in the
offender’s healthcare record.
Offender Consent to and then Refuses Treatment
If, after consenting to treatment, the offender again refuses and the conditions set forth
in this section are applicable, the offender may again be involuntarily administered
medication pursuant to the emergency involuntary administration of medication
procedures provided in this section. If this occurs, new 24-hour and 72-hour periods
begin.
NON-EMERGENCY INVOLUNTARY MEDICATION FOR OFFENDERS
7. Basis for Non-emergency Involuntary Medication
An offender may be subject to non-emergency involuntary medication but only if the
Involuntary Medication Hearing Committee (IMHC) holds an involuntary medication hearing,
and only if the IMHC finds that the offender:
• Suffers from a ‘mental disorder’ and is gravely disabled; and/or
• Suffers from a mental disorder and poses a likelihood of causing serious harm to
himself, others, or their property.
Note: Also see section 9, subsection titled ‘Involuntary Medication Hearing Officer
Responsibilities (Post-IMHC Deliberations)’.
Note: For the purpose of this SOP only, ‘mental disorder’ includes mental illness or
psychological disorders which may provide a basis for commitment to the Idaho
Security Medical Program pursuant to Idaho Code, section 66-1306 et seq.
Note: Non-emergency involuntary medication shall be administered only at facilities
with identified mental health or behavioral health units.
Other safeguards that the IMHC will consider when determining whether or not an offender
may be subject to non-emergency involuntary medication are when:
• A psychiatrist determined that the offender should be medicated;
• The offender did not consent to the medication after being given the opportunity to
do so;
• All available less restrictive options were exhausted, were shown to be ineffective, or
were likely to not be effective;
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• The psychiatrist determined that the potential benefits for the proposed medication
outweighed the risks associated with it; and
• A less restrictive means of non-emergency treatment was attempted and exhausted,
was not successful, was unlikely to succeed, and if true, specifically what means
were attempted or exhausted, and what was the basis for concluding that the
treatment did not succeed or was unlikely to succeed.
8. Pre-involuntary Medication Hearing Procedure
The involuntary medication hearing process shall be initiated when the treating psychiatrist
submits an Involuntary Medication Report to the facility head, chief psychologist, medical
director, or their designees. The Involuntary Medication Report shall include, but not be
limited to:
• The factual basis of the request for non-emergency involuntary medication;
• Observed behaviors and mental status of the offender;
• The factual basis for the offender’s tentative diagnosis from the current Diagnostic
and Statistical Manual of Mental Disorders (DSM);
• Documentation indicating the offender meets the criteria for non-emergency
involuntary medication;
• Methods used to encourage the offender to accept medication voluntarily and the
offender’s response to those efforts;
• The offender’s history of voluntary and involuntary non-emergency treatment;
• Whether less restrictive medically acceptable means of treatment are available, have
been attempted, have been effective, and the likelihood of their effectiveness;
• The medication suggested to treat the offender, the offender’s expected prognosis
with and without the medication, and the risks and benefits associated with it; and
• The likely duration of the medication.
Treating Psychiatrist Responsibilities
Upon submission of the Involuntary Medication Report, the treating psychiatrist shall
arrange for:
• Scheduling the involuntary medication hearing;
• Forwarding of a copy of the Involuntary Medication Report (via email or fax) to the
IMHC and making the offender’s healthcare record available to the IMHC no later
than 24 hours prior to the hearing; and
• Notifying the facility head (or designee) and chief psychologist of the hearing and
documenting this notification in the offender’s healthcare record.
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24 Hours Prior to Involuntary Medication Hearing: Offender’s Right to Refuse
Treatment
For a period of 24 hours prior to the involuntary medication hearing, the offender shall
not be subject to any medication for the ‘mental disorder’ (see section 7) for which non-
emergency involuntary medication is proposed.
Note: An offender receiving emergency involuntary medication shall have the right to
refuse medication during the same 24-hour period.
Involuntary Medication Hearing Officer Appointment
An involuntary medication hearing shall be facilitated and presided over by an
involuntary medication hearing officer.
In consultation with the Deputy Attorneys General (DAGs) who represent the IDOC, the
chief of the Operations Division (or designee) shall appoint an involuntary medication
hearing officer.
The involuntary medication hearing officer shall not have been involved in the treatment
of the offender for whom the involuntary medication hearing is being held for.
Involuntary Medication Hearing Officer Responsibilities (Pre-involuntary Medication
Hearing)
The involuntary medication hearing officer’s duties shall include, but not be limited to, the
following:
• Prior to serving the Notice of Involuntary Medication Hearing on the offender,
assigning a staff hearing assistant to assist the offender in the hearing and/or
appeal process;
• Arranging for an interpreter or translation service if the offender does not speak
English;
• Ensuring that an involuntary medication hearing record is kept (see section 9);
and
• Ensuring the involuntary medication hearing record (see section 9) and a Notice
of the Right to Appeal (see section 10) are delivered together to the offender.
Staff Hearing Assistant Appointment and Responsibilities
In consultation with the DAGs who represent the IDOC, the involuntary medication
hearing officer shall appoint a staff hearing assistant.
The staff hearing assistant must be an IDOC physician’s assistant, nurse practitioner, or
registered nurse who has not been directly involved in the offender’s treatment or
diagnosis.
The staff hearing assistant shall be responsible for assisting the offender with
understanding the medical and psychiatric issues involved in the involuntary medication
hearing process, and obtaining witness statements, other documents, or evidence.
If the offender is excluded from the involuntary medication hearing process, chooses not
to participate, or is unable to participate due to the severity of his ‘mental disorder’ (see
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section 7), the staff hearing assistant shall attend the hearing for the offender (having the
same rights as the offender) and represent the offender’s wishes as best as possible.
Prior to the involuntary medication hearing, the staff hearing assistant shall meet with the
offender and explain to him the following:
• The contents of the Notice of Involuntary Medication Hearing;
• The stated reason for the hearing;
• The medication being recommended, its expected result, and the likely outcome
without benefit of the medication;
• The reason the offender is being offered staff assistance;
• The hearing process and the offender’s right to attend the hearing;
• The offender’s right to challenge the recommended medications;
• The offender’s rights to speak at the hearing, to present witnesses and
documentary evidence, and to cross-examine witnesses;
• The offender’s right to an interpreter or translation service, if one is required; and
• The offender’s right to appeal the IMHC’s decision to the facility head.
Prior to the involuntary medication hearing, the staff hearing assistant shall determine
whether the offender requires an interpreter or translation service. If so, the staff hearing
assistant shall immediately inform the involuntary medication hearing officer. If
translation services are required but unavailable, the hearing should be delayed until
such services are available.
Notice of Involuntary Medication Hearing
No later than 24 hours prior to the scheduled involuntary medication hearing, the
offender shall be served with a Notice of Involuntary Medication Hearing. As designated
by the involuntary medication hearing officer, service may be performed by the staff
hearing assistant, a facility security staff member, or a clinician. The person performing
service shall execute a Return of Service and deliver it to the involuntary medication
hearing officer prior to the hearing.
The Notice of Involuntary Medication Hearing shall include:
• The date and time of the hearing;
• The reason for the hearing;
• The factual basis for the offender’s tentative diagnosis (from the current DSM) and
the data that supports it; and
• The evidence (see section 9) to be presented at the hearing that will be used to
establish whether the offender meets the criteria for non-emergency involuntary
medication. (The IDOC’s evidence will include why staff believes non-emergency
involuntary medication is necessary. The reasons why shall also be stated in the
Notice of Involuntary Medication Hearing.)
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Involuntary Medication Hearing Committee (IMHC) Responsibilities
The IMHC shall determine whether non-emergency involuntary medication is appropriate
based on the evidence presented at the involuntary medication hearing.
Note: No IMHC member shall at the time of the hearing be directly involved in the
offender’s treatment or diagnosis for the disorder for which non-emergency involuntary
medication is proposed.
Prior to the involuntary medication hearing, the IMHC shall review the Involuntary
Medication Report and the offender’s healthcare record.
Offender’s Non-participation or Exclusion From the Involuntary Medication Hearing
Process
The offender may elect to not participate or may be unable to participate in the
involuntary medication hearing process due to the severity of his ‘mental disorder’ (see
section 7). In such cases, the chair of the IMHC may request to the involuntary
medication hearing officer that (a) the staff hearing assistant act for the offender during
the hearing, and (b) the reasons why the offender is unable to participate be noted in the
involuntary medication hearing record (see section 9).
An offender may be excluded or removed from the involuntary medication hearing for (a)
safety or security reasons, or (b) if his behavior is so disruptive it is not possible to
otherwise proceed with the hearing. The involuntary medication hearing officer will state
for the involuntary medication hearing record (see section 9) the reasons why the
offender has been excluded or removed. If the offender is excluded or removed from the
involuntary medication hearing, (a) the hearing may proceed with the staff hearing
assistant representing the offender’s wishes, or (b) the involuntary medication hearing
officer may continue the hearing for no more than three (3) days.
9. Involuntary Medication Hearing Procedure
Involuntary Medication Hearing Officer Responsibilities (Pre-IMHC Deliberations)
The involuntary medication hearing officer shall:
• Convene and preside over the involuntary medication hearing;
• Determine whether translation services are necessary and available;
• Verify that the offender, staff hearing assistant, interpreter (if necessary), all IMHC
members, a DAG who represents the IDOC, and a person to create the
involuntary medication hearing record are present;
• Identify all personnel who are authorized to remain present for procedural,
security, clinical, legal, or training purposes;
• Inform those present of the rules and procedures that must be adhered to during
the hearing, and exclude all non-essential personnel;
• Verify that the offender received a Notice of Involuntary Medication Hearing at
least 24 hours prior to the hearing;
• Verify that the staff hearing assistant had the opportunity to consult with the
offender prior to the hearing, and the offender understands his rights and (a) can
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adequately understand the proceedings, or (b) the staff hearing assistant can
adequately represent the offender’s wishes at the hearing;
• Verify that the IMHC members have reviewed the Involuntary Medication Report,
the tentative diagnosis, and the offender’s healthcare record and/or mental health
record.
Presentation of Evidence
During the presentation of evidence, IMHC members may question any witness or the
offender.
The IDOC
The IDOC may present evidence through testimony, witnesses, or by records or
documents. Evidence of the need for non-emergency involuntary treatment, the
treatment proposed, the likelihood of the proposed treatment’s success, its benefits and
risks, and why less restrictive alternatives did not or will not work shall be presented by
the treating psychiatrist. The offender may examine the evidence and cross-examine the
IDOC’s witnesses.
The Offender
The offender may present evidence, through testimony, witnesses, or by records or
documents. The offender shall have the opportunity to state his preference as to non-
emergency involuntary treatment options. The IDOC may examine the evidence and
cross examine the offender’s witnesses.
In the event the offender is not present, has been removed or excluded, or is unable to
understand the hearing proceedings due to the severity of his ‘mental disorder’ (see
section 7), the staff hearing assistant may present and examine evidence, testify, and
cross-examine IDOC witnesses for the offender.
Inclusion or Exclusion of Evidence
Testimony from remote locations, including telephonic or videoconference testimony,
may be allowed at the discretion of the involuntary medication hearing officer. Written
witness statements provided by the offender may be considered upon a showing of good
cause why the witness could not personally appear.
The involuntary medication hearing officer may allow, limit, or exclude evidence and the
cross-examination of witnesses. Reasons for limiting or excluding evidence include, but
are not limited to: relevance and/or security considerations.
When the involuntary medication hearing officer limits or excludes evidence or the cross-
examination of witnesses, the reasons for doing so shall be reflected in the involuntary
medication hearing record.
The involuntary medication hearing officer shall ensure that the involuntary medication
hearing record reflects all witnesses giving testimony and all exhibits are entered into
the record.
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IMHC Deliberation
When the presentation of evidence is complete, the involuntary medication hearing
officer will allow the IMHC to deliberate on whether the offender meets the criteria for
being administered non-emergency involuntary medication.
Note: During deliberation, all personnel present (except for the IMHC members and the
DAG who represents the IDOC) must leave the room, no additional evidence may be
presented, and the facility head-designated staff member shall not take written minutes
or a transcription (if the hearing is being electronically recorded). However, the IMHC will
be allowed to consult with the DAG who represents the IDOC.
IMHC Responsibilities
The IMHC shall be responsible for rendering a decision based on the following:
• The Involuntary Medication Report;
• All evidence presented at the involuntary medication hearing;
• The offender’s healthcare record and/or and mental health record; and
• The offender’s stated preference for non-emergency involuntary treatment.
Note: The chair of the IMHC shall preside over their deliberations and summarize the
IMHC’s findings and evidence relied upon to reach a decision.
Involuntary Medication Hearing Officer Responsibilities (Post-IMHC Deliberations)
When the IMHC has concluded its deliberations and recorded its decision, it shall inform
the involuntary medication hearing officer and the offender shall be allowed to return to
the hearing proceedings.
The involuntary medication hearing officer shall inquire of the chair of the IMHC as to the
evidence relied upon to reach their decision.
Following inquiry as to the evidence considered, the involuntary medication hearing
officer shall inquire of the chair of the IMHC as to whether their decision was unanimous.
If their decision was unanimous, the chair of the IMHC shall speak to the decision made
and that decision and the reason for the decision reflected in the involuntary medication
hearing record.
If the decision was not unanimous, the involuntary medication hearing officer shall poll
each IMHC member as to their individual findings so that their findings can be reflected
in the involuntary medication hearing record.
Based on whether the decision was unanimous or not, the involuntary medication
hearing officer shall inquire to the chair of the IMHC or each IMHC member as to
whether they believe the evidence established that:
• The offender suffers from a ‘mental disorder’ (see section 7) and is gravely
disabled; and/or
• The offender suffers from a mental disorder and poses a likelihood of causing
serious harm to himself, others, or their property.
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Note: The involuntary medication hearing officer shall also inquire to the chair of the
IMHC whether or not the safeguards noted in section 7 were considered.
The chair of the IMHC must be in the majority of members who were polled to be in favor
of allowing the IDOC to administer non-emergency involuntary medication to the
offender.
The involuntary medication hearing officer shall ensure that the IMHC’s findings are
reflected in the involuntary medication hearing record.
If the IMHC’s findings support non-emergency involuntary treatment, the involuntary
medication hearing officer shall inform the offender of his right to an appeal (see section
10).
The involuntary medication hearing officer shall ensure that the involuntary medication
hearing record be finalized and as soon as possible be transmitted (via email or fax) to
the facility head, chief psychologist, medical director, and also provide the offender a
hard copy of the record.
The involuntary medication hearing officer may consult with a DAG who represents the
IDOC at any time during the non-emergency involuntary medication hearing.
Involuntary Medication Hearing Record
The facility head (or designee) shall designate a facility staff member to (a) be present at
the non-emergency involuntary medication hearing and (b) take written minutes or a
transcription (if the hearing was electronically recorded).
Note: During deliberation, the facility head-designated staff member shall not take
written minutes or a transcription (if the hearing is being electronically recorded).
At the conclusion of the non-emergency involuntary medication hearing, the facility
head-designated staff member shall finalize the written minutes or transcription.
The involuntary medication hearing record shall include, but not be limited to, the
following:
• Instructions by the involuntary medication hearing officer to those present;
• The involuntary medication hearing officer’s verification that the offender received
a Notice of Involuntary Medication Hearing, was advised of involuntary medication
hearing procedure and of his rights, had access to a staff hearing assistant, and
whether or not an interpreter was required;
• Whether or not the offender refused to participate, was unable to participate in the
non-emergency involuntary medication hearing due to the severity of his ‘mental
disorder’ (see section 7), or was excluded or removed from the hearing, and if the
latter, the grounds for excluding or removing the offender from the hearing;
• Whether or not all evidence and witnesses, cross-examination, and evidentiary
rulings were allowed;
• The IMHC’s findings;
• Whether or not the IMHC found in favor of allowing the IDOC to administer non-
emergency involuntary medication to the offender; and
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• Whether or not the offender was informed of his the right to appeal the IMHC’s
decision to the facility head.
The involuntary medication hearing record shall not reflect any consultation the
involuntary medication hearing officer and/or an IMHC member had with a DAG who
represents the IDOC.
Facility Head-Designated Staff Member’s Responsibilities
The facility head-designated staff member who is responsible for finalizing the
involuntary medication hearing record shall forward the record (via email or fax) to the
involuntary medication hearing officer within 24 hours of the conclusion of the non-
emergency involuntary medication hearing. Upon the involuntary medication hearing
officer’s approval, the staff member shall, as soon as possible, transmit the record (via
email or fax) to the facility head, chief psychologist, medical director, and also provide
the offender a hard copy of the record.
10. Appeal and Automatic Review of IMHC’s Decision
An offender shall have the option to appeal the IMHC’s decision to the facility head within 24
hours of receiving a hard copy of the involuntary medication hearing record.
In addition to the offender’s option to appeal the IMHC’s decision, and regardless of whether
the offender exercises that option, the facility head shall automatically review the decision.
In conducting the automatic review, the facility head must consider the involuntary
medication hearing record and if the offender appealed, all reasons set forth by the offender
as the basis for the appeal.
Except on the grounds that the IMHC’s decision was based on inaccurate or erroneous
factual evidence, the facility head shall not override the IMHC’s decision. The facility head
does not and shall not have the authority to override an IMHC decision based on medical
grounds.
If the facility head overrides the IMHC’s decision based on inaccurate or erroneous factual
evidence, the facility head’s decision shall be in writing and specific reasons documented for
overriding the IMHC’s decision.
• In cases where the offender exercises his option to file an appeal, the facility head
shall render a decision within one business day of receiving the appeal.
• In cases where the offender did not exercise his option to file an appeal, the facility
head shall render a decision within one business day of receiving a copy of the
involuntary medication hearing report.
• In all cases, the facility head should consult with a DAG who represents the IDOC
when determining an offender’s appeal or an automatic review.
• In all cases, the facility head shall forward (via email or fax, as soon as possible) his
decision to all IMHC members, the DAG, the chief psychologist, the medical director,
and also provide the offender a hard copy of the decision.
Note: The offender must be informed of the facility head’s decision prior to the IDOC being
allowed to administer non-emergency involuntary medication to the offender.
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In cases where the facility head overrides the IMHC’s decision, the facility head’s decision
shall constitute a remand, and the case shall be returned to the IMHC. In the case of a
remand, the IMHC shall reconvene, and may:
• Accept the facility head’s decision and issue a new decision to not allow the IDOC to
administer non-emergency involuntary medication to the offender; or
• Set the matter for another involuntary medication hearing as soon as possible, with
instructions to the IDOC to address the specific items set forth in the facility head’s
decision.
Note: If the IMHC conducts another involuntary medication hearing, the IMHC’s decision
shall again be subject to the appeal and automatic review process described in this section.
11. Periodic Review of the Administration of Non-emergency Involuntary Medication
After an involuntary medication hearing decision, the administration of non-emergency
involuntary medication may continue for up to 180 days, and only upon periodic review, as
set forth in this section.
After the first seven days of administering non-emergency involuntary medication, the
treating psychiatrist shall prepare an Involuntary Medication Report regarding the offender’s
progress to the IMHC. The IMHC shall review the offender’s case, consult, and either re-
approve non-emergency involuntary medication or discontinue it. The IMHC’s consultation
of members may be in person or via electronic media (e.g., telephone, email, and
teleconferencing). The IMHC’s decision shall be transmitted (via email or fax) by the chair of
the IMHC to the treating psychiatrist.
If the IMHC re-approves non-emergency involuntary medication, the treating psychiatrist
shall, for every 14 days thereafter while the non-emergency involuntary medication
continues, prepare an Involuntary Medication Report regarding the offender’s progress to
the health authority.
At the end of each 180 day period, another IMHC shall be convened and new findings must
be made to continue the non-emergency involuntary medication. If non-emergency
involuntary medication is again approved, the offender may appeal and the automatic review
(see section 10) and periodic review (see this section) processes shall again take place.
NON-EMERGENCY INVOLUNTARY MEDICATION FOR OFFENDERS DEEMED UNFIT FOR
CRIMINAL TRIAL
12. Idaho Security Medical Program (ISMP)
Pursuant to Idaho Code, section 18-212 and 66-1304(a), an offender may be committed to
the Idaho Security Medical Program (ISMP) upon a finding that the offender is unfit to
proceed in his criminal case. In such cases, non-emergency involuntary medication shall not
be administered solely for purposes of rendering an offender competent to stand trial,
except where the court which has jurisdiction over the criminal case and which has ordered
the offender’s commitment to the ISMP has made findings that:
• Important governmental interests are at stake in bringing the offender to trial;
• Non-emergency involuntary medication will significantly further those interests;
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• Non-emergency involuntary medication is necessary to further those interests;
• Non-emergency involuntary medication is medically appropriate; and
• The IDOC is therefore authorized to administer non-emergency involuntary
medication for purposes of rendering the offender competent to stand trial.
The administration of non-emergency involuntary medication under this section may take
place only upon the chief psychologist’s expressed authorization, based on a review of the
applicable court order and consultation with the facility head, a DAG who represents the
IDOC, and the director of the IDOC.
Pursuant to Idaho Code, section 66-1306, the director of the IDOC retains discretion to
discharge an offender from the ISMP at any time.
REFERENCES
Balla v. Idaho State Board of Correction, 869 F.2d 461 (9th Cir. 1989)
Idaho Code, Title 18, Chapter 2, Section 18-212, Determination of Fitness of Defendant to
Proceed – Suspension of Proceeding and Commitment of Defendant – Postcommitment
Hearing
Idaho Code, Title 66, Chapter 13, Idaho Security Medical Program
Idaho Code, Title 66, Chapter 13, Section 66-1304, Sources of Residents
Idaho Code, Title 66, Chapter 13, Section 66-1306, Final Decision
Idaho Code, Title 66, Chapter 13, Section 66-1307, Return of Patient
Idaho Code, Title 66, Chapter 13, Section 66-1308, Transport of Patients
Idaho Code, Title 66, Chapter 13, Section 66-1309, Costs and Charges
Idaho Code, Title 66, Chapter 13, Section 66-1310, Civil Rights of Residents
Idaho Code, Title 66, Chapter 13, Section 66-1311, Right to Humane Care and Treatment
Idaho Code, Title 66, Chapter 13, Section 66-1312, Standards for Treatment
Idaho Code, Title 66, Chapter 13, Section 66-1313, Mechanical Restraints
Idaho Code, Title 66, Chapter 13, Section 66-1314, Interstate Contracts
Idaho Code, Title 66, Chapter 13, Section 66-1315, Short Title
Idaho Code, Title 66, Chapter 13, Section 66-1316, Patients from Other Institutions
Idaho Code, Title 66, Chapter 13, Section 66-1317, Review of Involuntary Treatment
Idaho Code, Title 66, Chapter 13, Section 66-1318, Transfer of Noncorrectional Facilities
National Commission on Correctional Health Care (NCCHC), Standards for Health Services
in Prisons, Standard P-I-02, Emergency Psychotropic Medication
National Commission on Correctional Health Care (NCCHC), Standards for Health Services
in Prisons, Standard P-I-05, Informed Consent and Right to Refuse
Riggins v. Nevada, 504 U.S. 127 (1992)
Sell v. United States, 539 U.S. 166 (2003)
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Standard Operating Procedure 307.02.01.001, Use of Force: Prisons and Community
Reentry Centers (CRCs)
Standard Operating Procedure 316.02.01.001, Grievance and Informal Resolution
Procedure for Offenders
Standard Operating Procedure 401.06.03.070, Informed Consent
Standard Operating Procedure 401.06.03.071, Right to Refuse Treatment
Standards for Adult Correctional Institutions, Third Edition, Standard 3-4342
Vitek v. Jones, 445 U.S. 480 (1980)
Washington v. Harper, 494 U.S. 210 (1990)
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