"Your Rights and Responsibilities in Making Medication Choices"
a P&A Self-Help Publication

INTRODUCTION

As of October 1, 1993, inpatients in psychiatric units or hospitals who are eighteen years of age or older have a right to refuse medication,  Public Act 93-369. These changes are in the Patient’s Bill of Rights, C.G.S. §17a-540 et. seq. Amendments were made to this law and signed by the Governor on June 4, 1996, effective immediately. The amendment includes allowing inpatients age 16 and older to refuse medication and clarifying the role of a conservator in making medication decisions.

MAKING INFORMED MEDICATION DECISIONS

If it is the hospital’s opinion that medication be prescribed for you, they now must ask you for your permission. In order for you to make an informed decision, however, they must provide you with the following information:

• the reason for the medication;
• the nature of the medication;
• the pluses and minuses of the medication;
• any alternative medication that is medically acceptable for you;
• the risks of taking the medication; and
• the risks of not taking the medication.

After you are fully informed of the reasons and risks associated with the medication, you should respond whether or not you agree with their decision.

If you disagree, the hospital can:

• agree;
• further discuss their concerns with you;
• decide that without medication your behavior puts you or others in "direct threat or harm;" or
• find you unable to make the decision.

If the hospital determines that (1) you are unable to give your permission or make a knowledgeable decision abut the medication or (2) without the medication your behavior is a "direct threat of harm," and they want to medicate you against your wishes, the hospital must hold an internal hearing and/or file in Probate Court prior to medicating you.

INTERNAL PROCEDURES APPEAL PROCESS

The hospital may establish an internal hearing process to medicate you without your permission. If you lose the internal hearing, the hospital will medicate you against your wishes for 30 days while you appeal directly to the Probate Court. Probate Court must schedule an appeal of your medication hearing within 15 days.

The hospital’s internal procedure is a review of your decision to refuse medication. The hospital must:

• provide a hearing officer who is someone not employed by the hospital;
• given you a list of advocacy services available to you
• give you 48 hours notice of the hearing;
• allow you and/or your advocate, if you have one, a reasonable chance to discuss with the facility the individual who is to be chosen as the hearing officer;
• permit you or your representative to question any witnesses including one or both of the physicians who made the medication decision; and
• provide you and your representative with a written decision.

If the resulting decision is that you should receive the medication and there is a strong possibility that without it your mental condition will rapidly deteriorate, you may be medicated for no more than 30 days or until discharge whichever comes first.

IF YOU ARE UNABLE TO GIVE YOUR PERMISSION FOR MEDICATION

If the head of the hospital and two physicians agree that you are unable to give your permission for the medication, they may apply to Probate Court for a conservator with specific authority to consent to medication for you. If you have a conservator already, the hospital must still petition the Probate Court to grant the authority to the conservator to consent to medication. If your income level is low, you may be eligible for free legal representation in Probate Court.

Once a conservator has been appointed for you, he/she must:

• meet with you and your physician(s);
• review the written medical record;
• consider the risks and benefits of the medication and possible negative side effects;
• consider what would happen to your mental health if you do not take the medication.

After this happens, the conservator will make a decision whether or not you should receive the medication. If your conservator decides that you should be given the medication, you may be medicated for no more than 120 days. Once you are discharged from the hospital, the conservator does not have the authority to force you to take medication. The 120 day authority ends upon your discharge. If you remain in the hospital beyond the 120 days and the hospital still feels you are not capable of providing informed consent to the medication, then the 120 day order can be extended for another 120 days without a hearing if the hospital petitions Probate Court. You have the right to a hearing if you disagree with the second 120 day order.

If an internal hearing is held pending the appointment of a conservator and you lose your right to refuse medication, you can receive medication for up to 30 days or until discharge.

APPEALS OF PROBATE COURT

If you have a Probate Court hearing and the Court finds that you need the medication, you can only receive medication for up to 120 days. If you want to appeal the medication decision beyond Probate Court, you will need legal representation. This appeal is to the Connecticut Superior Court and it might be difficult for you to do this without legal assistance.

EMERGENCY MEDICATION

With the exception of the previously described criteria, you can only be medicated without your permission in an emergency situation. Emergency medication is intended to be for a short period of time to address the emergency. A decision to provide emergency medication without your permission can only be made by a physician or the senior clinician on duty after personally observing you.

Some hospitals may have internal policies governing the use of emergency medication. You have a right to be informed of their policy. Ask the hospital staff for further information or contact an advocate if you feel the use of emergency medication is unnecessary.