D.C. Mun. Regs. r. 22-A104
Each MH provider shall obtain informed consent from each consumer prior to administering medication for the purposes of mental health treatment, except as described in § 104.4 through § 104.17 of this chapter.
Prior to administering any medication for purposes of mental health treatment, a MH provider shall present the consumer with information about the proposed medication, including, but not limited to:
Each MH provider shall obtain the consumer's written informed consent to administration of medication, prior to prescribing and administering such medication. Such informed consent shall be documented in the consumer's clinical record. If the consumer consents to treatment with medication but is not willing or able to give consent in writing, the MH provider shall document this in the consumer's clinical records prior to beginning treatment with medication and document the reason the consumer has not given written consent.
If, after presenting the information described in § 104.2, the MH provider and the consumer's attending or treating physician believe that the consumer is incapable of making a decision about treatment with medication, the MH provider and consumer's attending or treating physician shall seek certification of incapacitation in accordance with § 102.1. If a consumer has been certified as incapacitated for purposes of making a health care decision, the MH provider shall seek informed consent to the proposed treatment in accordance with § 11 of the HCDA (D.C. Official Code § 21-2210 ).
Any consent to the administration of medication by a consumer's attorney-in-fact or substitute health care decision-maker must be consistent with the consumer's treatment preferences, as expressed in a validly executed durable power of attorney for health care or declaration of advance instructions for mental health treatment.
A MH provider may administer medication for mental health treatment to an incapacitated consumer without the consumer's written informed consent, pursuant to the MH provider's policy that shall be approved by DMH and shall be consistent with these rules and other relevant Federal and local laws and regulations, in:
A consumer's refusal to consent to the administration of medication on the basis of a valid religious objection shall not be overridden, in either an emergency or non-emergency, without a valid court order.
The Director or his/her designee shall designate a neutral person within DMH or the MH provider to serve as the internal reviewer of the necessity for involuntary administration of medication (Medication Review Officer).
A MH provider seeking approval of involuntary administration of medication to an incapacitated consumer shall:
The Medication Review Officer shall schedule a meeting with the MH provider, the consumer and the consumer's representative, and the psychiatrist seeking to administer the medication. The consumer, the MH provider and the psychiatrist shall have the opportunity to present information about the proposed treatment with medication, the necessity for administering the medication, the consumer's capacity to make a decision about the proposed medication, and the consumer's reasons for not consenting to medication. In addition, the Medication Review Officer shall review the consumer's advance directive or declaration of advance instructions, if one exists.
The Medication Review Officer shall document the outcome of the review of the need for involuntary administration of medication in a written report to be included in the consumer's clinical record. In addition, a copy of the report shall be submitted to the Director or the Chief Clinical Officer, the consumer, the MH provider and the consumer's treating psychiatrist within three (3) business days after the meeting. The Medication Review Officer's report shall state whether the medication may be administered over the consumer's objection. If the Medication Review Officer's report authorizes the administration of medication, it shall be valid for a maximum of thirty (30) days from the date of issuance. The written report shall include the following:
If the Medication Review Officer concurs in the conclusion that the consumer lacks the capacity to make a decision regarding treatment with medication and determines that the consumer should be treated with medication without informed consent, then the Medication Review Officer shall notify the consumer and the consumer's representative, if one is involved, that the consumer may seek a review of the decision with the DMH Medication Review Panel.
The consumer shall have the right to appeal the Medication Review Officer's decision to the DMH Medication Review Panel. Within one (1) day of the date of the Medication Review Officer's decision, the consumer or the consumer's personal representative must inform the Medication Review Officer or the Chief Clinical Officer if the consumer would like to appeal the Medical Review Officer's decision. If the consumer would like his or her representative to participate in the Medication Review Panel process, then the consumer or the representative must inform the Medication Review Officer or the Chief Clinical Officer whether there are any times in the next 72 hours when the representative would not be available.
The Director shall appoint a Medication Review Panel to review decisions of the Medication Review Officer, if the consumer has requested an appeal. The members of the Medication Review Panel shall:
The DMH Medication Review Panel shall convene within seventy-two (72) hours of receipt of the appeal and shall review the Medication Review Officer's decision. Notice of the time for the DMH Medication Review Panel meeting shall be provided to the consumer and the consumer's representative, if one has been involved. The Medication Review Panel shall convene at the MH provider facility where the consumer receives services.
The Medication Review Officer's decision shall be stayed pending review by the DMH Medication Review Panel.
The DMH Medication Review Panel shall issue a decision upholding or overturning the Medication Review Officer's decision within one (1) day of its meeting.
D.C. Mun. Regs. r. 22-A104