Consent to Medical Treatment for Youth in the Juvenile ...youthlaw.org/wp-content/uploads/2016/02/Juv... · Treatment for Youth in the Juvenile Justice System: California Law A Guide

Consent to Medical Treatment for Youth in the Juvenile Justice System: California Law A Guide for Health Care Providers

Rebecca Gudeman, J.D., M.P.A National Center for Youth Law

Teen Health Rights Initiative

November 2009

Consent to Medical Treatment for Youth in the Juvenile Justice System: California Law

ThispublicationwascreatedbytheNationalCenterforYouthLawaspartofitsTeenHealthRightsInitiative,whichprovidesinformationandresourcestoprovidersofadolescenthealthservices.NationalCenterforYouthLaw40514thSt.,Suite1500Oakland,CA94612www.youthlaw.orgwww.teenhealthrights.orgTheNationalCenterforYouthLawisanational,non‐profitorganizationthatusesthelawtoimprovethelivesofpoorchildren.NCYLworkstoensurethatlow‐incomechildrenhavetheresources,supportandopportunitiestheyneedforahealthyandproductivefuture.MuchofNCYL’sworkisfocusedonpoorchildrenwhoareadditionallychallengedbyabuseandneglect,disabilityorotherdisadvantage.Acknowledgements:SincerethankstoAliceBussiere,YouthLawCenter;andNancyTorrey,JuvenileOffendersCommunityHealthServices(JOCHS)forreviewingandcommentingonthisdocument;ThankstoNCYL’sAllisonCrapoandFizaQuarashifortheirreview;andspecialthankstoChristianaMacFarlaneforresearchandwritingassistanceandtoNCYLlawclerkLinneaForsythe.Disclaimer:Thismanualprovidesinformation.Itdoesnotconstitutelegaladviceorrepresentation.Forlegaladvice,readersshouldconsulttheirowncounsel.ThismanualpresentsthestateofthelawasofJune2009.Whilewehaveattemptedtoassuretheinformationincludedisaccurateasofthisdate,lawsdochange,andwecannotguaranteetheaccuracyofthecontentsafterpublication. Thisdocumentmaybereproducedfornon‐commercialpurposesprovidedanyreproductionbeaccompaniedbyanacknowledgement.Allotherrightsreserved.

Table of Contents

I.INTRODUCTION .......................................................................................................................1

II.WHOMAYCONSENTFORCHILDREN’SHEALTHCARE? ....................................................2

III.WHOCONSENTSFORCAREWHENMINORSAREINVOLVEDWITHTHEJUVENILEJUSTICESYSTEM? ........................................................................................................................2

A. GeneralRule..................................................................................................................................2B. AdditionalPersonsWhoMayConsentforCare ......................................................................3

1. TheProbationOfficer..............................................................................................................................32. TheJuvenileCourt....................................................................................................................................43. Caregivers....................................................................................................................................................54. TheDepartmentofCorrectionsandDepartmentofJuvenileJustice ....................................5

C. ConsentRulesinSpecialCircumstances ...................................................................................61. EmergencyCare ........................................................................................................................................62. TemporaryCustody .................................................................................................................................73. TreatmentasaConditionofProbation ............................................................................................8

D.ConsentandAccessRuleswhenMinorisinaCountyFacility ................................................91. RightstoSpecificServicesandConsentRuleswhileDetained/Committed.........................92. RighttoHealthCareandScreens .......................................................................................................93. RighttoRefuseTreatmentwhileDetained/Committed ..........................................................10

E. ConsentRulesforSpecialServices.......................................................................................... 111. DiagnosingChildAbuse .......................................................................................................................112. HIV/AIDS:TestingandTreatment....................................................................................................113. Infectious,ContagiousorCommunicableDiseases:TestingandTreatment....................124. MentalHealth:AssessmentandCounseling(Outpatient) ......................................................135. MentalHealth:InpatientHospitalization......................................................................................146. MentalHealth:PsychotropicMedications ..................................................................................16

• WhenCourtAuthorizationisNecessary .....................................................................................................16• EmergencyProvisionofMedicationAbsentaCourtOrder .................................................................17• MedicationforWardsinFacilities ................................................................................................................18• RighttoRefuseMedication .............................................................................................................................18

7. PregnancyandotherReproductiveHealthCare ........................................................................198. PregnancyandotherReproductiveHealthCareforYouthinJuvenileFacilities ............20

• MinorConsent .....................................................................................................................................................20• BirthControl/FamilyPlanning ........................................................................................................................20• PregnancyTestingandPregnancyCare ......................................................................................................21• Abortion .................................................................................................................................................................21• Childbirth ...............................................................................................................................................................21

9. SexuallyTransmittedDiseases..........................................................................................................2210. SexualAssaultTreatment.................................................................................................................2211. SubstanceAbuse:TestingandTreatment.................................................................................23

1 © National Center for Youth Law 2008

I.INTRODUCTIONAdolescentsinvolvedwiththejuvenilejusticesystemhavesignificanthealthcareneedsandworsehealthoutcomesthantheirpeersnotinvolvedwiththesystem.1Whenyouthenterthejuvenilejusticesystem,2thestatebecomesinvolvedinprovidinghealthcaretotheminmanyways.Forexample,thejuvenilecourtmayorderthataprobationofficerobtaintheservicesofvarioushealthexpertstodeterminetheappropriatetreatmentforaminoronceapetitionhasbeenfiledtomakeaminorawardofthecourt.3Ifaminoristakenintostateorcountycustody,thestateorcountymustprovidefortheyouth’sbasichealthcareneeds.4Iftheminorisplacedonprobation,thecourtmayimposeconditionsontheminor,includingthattheminorparticipateinhealthcareservicessuchasmentalhealthorsubstanceabusetreatmentprograms.5Inallthesecases,though,medicalservicescannotbeginwithoutobtainingtheappropriateconsenttocare.Whomayconsentforthatcarewillvary.Thus,thedeliveryofhealthservicestoyouthinvolvedwiththejuvenilejusticesystemdependsinpartonunderstandinghealthconsentlaw.ThisdocumentdescribesthemedicalconsentrulesthatapplywhenminorsareinvolvedwiththeCaliforniajuvenilejusticesystem‐‐includingminorswhohavebeenadjudicateddelinquentandminorswhohavebeentakenintocustodybutnotyetadjudicated.Youthcome withinthejurisdictionofthejuvenilecourtwhentheyeither(1)habituallydisobeytheirparentsoraretruantor(2)engageincriminalbehavior.Cal.Welf.&Inst.Code§§601,602.Whenthathappens,theymaybetakenintotemporarycustodyanddetainedinajuvenilefacility.Aprobationofficerordistrictattorneymayfileapetitiontodeclaretheminorawardofthecourt.Thejuvenilecourt,afterconsideringtheevidence,maydeclaretheminorawardofthecourtorplacetheminoronprobationunderthesupervisionofaprobationofficer.Cal.Welf.&Inst.Code§725.Iftheminorisdeclaredaward,thecourtmayplacethewardinacountyfacility,agrouphomeorunderparentorguardiansupervision.AsmallpercentageofwardsarecommittedtotheDepartmentofCorrectionsorDivisionofJuvenileFacilities(formerlyknowntheDepartmentoftheYouthAuthority,hereinafterreferredtoas“DJJ”).6Thedocumentwillnotewhenrulesapplyonlytominorsatacertainstageofthejuvenilecourtprocess,forexample,onlytominorsintemporarycustody,oronlytominorsincertainfacilities.TherulesthatapplywhenchildrenenterthejuveniledependencysysteminCaliforniaaredescribedin

1Seee.g.K.Clark,S.Gehshan,MeetingtheHealthNeedsofYouthInvolvedintheJuvenileJusticeSystem,2006,Nat.Acad.StateHealthPolicy;ManaGolzari,BA,StephenJ.Hunt,PhDc,ArashAnoshiravani,MD,MPH,Thehealthstatusofyouthinjuveniledetentionfacilities.JournalofAdolescentHealth.38(6):776‐782.June2006.(p.777,778)2 Ca.LegislativeAnalyst’sOffice,California’sCriminalJusticeSystem:APrimerChapter5(January31,2007),availableathttp://www.lao.ca.gov/2007/cj_primer/cj_primer_013107.aspx#chapter5.3Cal.Welf.&Inst.Code(hereinafterWIC)§741.4U.S.Constitution,FourteenthandEighthAmendments;seeEstellev.Gamble,429U.S.97,104(1976);D.B.v.Tewksbury,545F.Supp.896(D.Or.1982);AlexanderS.v.Boyd,876F.Supp.773,788,796(D.S.C.1995).5WIC§727(a).6Inthisdocument,theterm“ward”isusedbroadlytodescribeminorsfromthetimetheyfirstcomeunderthejurisdictionofthejuvenilecourtduetobehavior,asdescribedinWIC§§601or602,aswellasminorswhohavebeenadjudicatedwardsofthejuvenilecourt.Thedocumentwillpointoutwhenspecificrulesapplyy.

“ConsenttoMedicalTreatmentforFosterYouth:CaliforniaLaw,”availableatwww.TeenHealthRights.org.II.WHOMAYCONSENTFORCHILDREN’SHEALTHCARE?Allnon‐emergencyhealthcarerequiresconsentbeforetreatmentcanbeprovided.Whenapatientisaminorchild,aparentorlegalguardiangenerallymustconsentforthatchild’smedicaltreatment.Therearesomeexceptionstothisruleofcourse.Forexample,adultcaregiversoftenmayconsenttomedicaltreatmentforchildrenundertheircare,evenifthecaregiverdoesnothaveformallegalcustodyofthechild.7Andminorsmayconsentfortheirownmedicaltreatmentwhentheymeetcertainstatusconditions,suchasbeingmarried,orwhentheyareseekingcertaintypesofcare,suchasdrugabusetreatmentorpregnancy‐relatedservices.8

III.WHOCONSENTSFORCAREWHENMINORSAREINVOLVEDWITHTHEJUVENILEJUSTICESYSTEM?

A. GeneralRuleAsageneralrule,thesameconsentrulesthatapplyoutsidethejuvenilejusticesystemapplywhenservicesareprovidedtoyouthinvolvedinthejuvenilejusticesystem.Whereparentorguardianconsentwouldhavebeenrequiredforservicesoutsidejuvenilejustice,parentorguardianconsentisnecessarytoreceivethoseservicesonceaminorisinvolvedwiththesystem.Andwhereminorconsentwouldhavebeenrequiredoutside,minorconsentisrequiredonceaminoriswithinthesystem.However,thegeneralrulehasseveralimportantexceptions.

1. First,whileentryintothejuvenilejusticesystemdoesnotautomaticallyremoveaparent’srighttoconsenttotheirchild’shealthcare,thejuvenilecourtdoeshavetheauthoritytoremoveaparent’srighttoconsenttomedicalcareonceaminorisadjudicatedawardofthecourt.9Ifthecourtexercisesitsauthorityandremovesaparent’srighttoconsent,thecourtmustputthatremovalinacourtorder.10Thatsameorderlikelywillplaceprimaryconsentrightswithsomeoneelse,suchasaprobationofficer.

2. Second,Californialawallowsadditionalpeopletoconsentforaward’shealthcareat

times.Thisdoesnotmeantheparentorotherpersonwhoholdsprimaryconsentrightshasbeendivestedofhisorherauthority.11Rather,thelawsimplyprovidesadditional

7Cal.Fam.Code§§6550,6552.8Cal.Fam.Code§§6924‐6929.Forcompleteinformationonminorconsentservices,seeMinorConsent,ConfidentialityandChildAbuseReportinginCalifornia,availableatwww.TeenHealthRights.org.9WIC§726(a)(“Inallcasesinwhichaminorisadjudgedawardordependentchildofthecourt,thecourtmaylimitthecontroltobeexercisedoverthewardordependentchildbyanyparentorguardianandshallinitsorder,clearlyandspecificallysetforthallthoselimitations...”).10Id.11Seee.g.WIC§739(f)(“Nothinginthissectionshallbeconstruedaslimitingtherightofaparent,guardian,orpersonstandinginlocoparentis,whohasnotbeendeprivedofthecustodyorcontroloftheminorbyorderofthecourt,inprovidinganymedical,surgical,dental,orotherremedialtreatmentrecognizedorpermittedunderthelawsofthisstate.”).

optionstoensurenecessaryservicescanbeprovidedinatimelymanner.Theserulesareexplainedinsection(B)below.

3. Third,therearespecificconsentrulesthatapplywhenaminorundercourtjurisdictionor

courtproceedingsneedscareinspecialcircumstances,suchasinanemergency.Theserulesareexplainedinsection(C)below.

4. Fourth,therearesomespecialconsentandaccessrulesthatapplywhenaminoris

placedinastateorcountyfacility.Theserulesareexplainedinsection(D)below.

5. Finally,therearespecificconsentrulesthatapplywhenaminorundercourtjurisdictionorcourtproceedingsneedscertaintypesofspecialtycare,suchaspregnancycareormentalhealthtreatment.Theserulesareexplainedinsection(E)below.

B. AdditionalPersonsWhoMayConsentforCareInadditiontowhoeverholdsprimaryconsentrights,severalothersmaygiveconsentforthehealthcareorawardoraminorotherwiseunderthejurisdictionofthejuvenilejusticesystem,accordingtothefollowing:

1. TheProbationOfficer

Aprobationofficermayprovideconsentformedicaltreatmentinthefollowingsituations:

• Whenaminorisintemporarycustody,12theprobationofficermayconsentfor

necessaryhealthcare,asrecommendedbyanattendingdoctorordentist.Beforeprovidingauthorization,however,theprobationofficermustnotifytheparent,guardianorpersonstandinginlocoparentis.Ifthispersonobjects,carecannotbeprovidedwithoutacourtorderauthorizingtreatment,unlessitisanemergency.Cal.Welf.&Inst.Code§739(a).13

• Inemergency14situations,theprobationofficermayprovideconsentto

necessarymedicalcareforminorsunderthejurisdictionofthejuvenilecourt;however,beforeprovidingauthorization,theofficermustmakereasonableeffortsto“obtaintheconsentof,ortonotify,theparent,guardianorpersonstandinginlocoparentispriortoauthorizingcare.”Cal.Welf.&Inst.Code§739(d).15Seesection(C)belowformoreonconsenttoemergencycare.

12SeeWIC§625.13WIC§739(a)(“…iftheparent,guardian,orpersonstandinginlocoparentisobjects,thecareshallbegivenonlyuponorderofthecourtintheexerciseofitsdiscretion.”).14WIC§739(d)(“‘Emergencysituation,’forthepurposesofthissubdivisionmeansaminorrequiresimmediatetreatmentforthealleviationofseverepainoranimmediatediagnosisandtreatmentofanunforeseeablemedical,surgical,dental,orotherremedialconditionorcontagiousdiseasewhichifnotimmediatelydiagnosedandtreated,wouldleadtoseriousdisabilityordeath.”).15WIC§739(d)(“Wheneveritappearsthataminor…requiresimmediateemergency,medical,surgical,orotherremedialcareinanemergencysituation,thatcaremaybeprovidedbyalicensedphysicianandsurgeon,oriftheminorneedsdentalcare…,byalicenseddentist,withoutacourtorderanduponauthorizationofaprobationofficer.

• Thecourt,viaacourtorder,maygranttheprobationofficertherighttoconsent

tomedicalcareonaminor’sbehalf.Beforegivingthisauthoritytotheprobationofficer,thecourtmustgiveduenoticetotheminor’sparent,guardian,orpersonstandinginlocoparentis.Cal.Welf.&Inst.Code§739(c).16Aconsentorderisnotthesameasa“care,custodyandcontrol”order.Whenchildrenaremadewardsofthecourt,thecourtsometimesordersthat“care,custodyandcontrol”ofthewardbeplacedunderthesupervisionoftheprobationofficer.The“care,custodyandcontrol”order,onitsown,doesnotgivetheofficertherighttoconsentformedicalcare.Fortheprobationofficertohavetherighttoconsenttocare,thecourtmustmakeaseparateconsentorder.17Somecountiesmayhavestandingcourtordersorlocalcourtrulesgivingprobationtherighttoauthorizecareincertaincircumstances.Seeyourlocalcourtrulesandordersforguidance.

2. TheJuvenileCourt

Thejuvenilecourtjudgeorhearingofficermayprovideconsentformedicaltreatmentinthefollowingsituations:

• Thecourtmayauthorizetreatmentforaminorifalicensedphysicianrecommendstreatment,andthejuvenilecourtfindsthatnoparent,guardian,orpersonstandinginlocoparentisiswillingandabletoprovideconsent.Cal.Welf.&Inst.Code§739(b).18Insomecounties,thecourtshaveissuedstandingcourtordersorlocalcourtrulesauthorizingcertainhealthcareproviderstodeliverspecificservicestowards.Forexample,MendocinoCounty’sJuvenileCourthasgrantedcommunityclinicsandtheDepartmentofMentalHealththerighttoperformhealthassessmentsandprovidetreatmentforalltemporarilydetainedminorsviaalocalcourtrule.19Similarly,SantaClara’sjuvenilecourthasalocalcourtrulethatgrants“SantaClaraValleyMedicalCentermedicalclinics”theauthoritytoprovideacertainrangeofassessmentsandtreatmentto“juvenilesconfinedintheSantaClaraCountyProbationDepartmentandDepartmentof

…Theprobationofficershallmakereasonableeffortstoobtaintheconsentof,ortonotify,theparent,guardian,orpersonstandinginlocoparentispriortoauthorizingemergency…care.”).16WIC§739(c)(“Wheneverawardofthejuvenilecourtisplacedbyorderofthecourtwithinthecareandcustodyorunderthesupervisionoftheprobationofficerofthecountyinwhichthewardresidesanditappearstothecourtthatthereisnoparent,guardian,orpersonstandinginlocoparentiscapableofauthorizingorwillingtoauthorizemedical,surgical,dental,orotherremedialcareortreatmentfortheward,thecourtmay,afterduenoticetotheparent,guardian,orpersonstandinginlocoparentis,ifany,orderthattheprobationofficermayauthorizethemedical,surgical,dental,orotherremedialcareforthewardbylicensedpractitioners,asmayfromtimetotimeappearnecessary.”).17SeeWIC§§726(a);727(a);739(c).18WIC§739(b)(“Wheneveritappearstothejuvenilecourtthatanypersonconcerningwhomapetitionhasbeenfiledwiththecourtisinneedofmedical,surgical,dental,orotherremedialcare,andthatthereisnoparent,guardian,orpersonstandinginlocoparentiscapableofauthorizingorwillingtoauthorizetheremedialcareortreatmentforthatperson,thecourt,uponthewrittenrecommendationofalicensedphysicianandsurgeonor,ifthepersonneedsdentalcare,alicenseddentist,andafterduenoticetotheparent,guardian,orpersonstandinginlocoparentis,ifany,maymakeanorderauthorizingtheperformanceofthenecessarymedical,surgical,dental,orotherremedialcareforthatperson.”).19 MendocinoSup.Ct.R.16.11.

FamilyandChildren’sServices’temporaryholdingfacilities.”20AndAlamedaCountyhasastandingcourtorderthatauthorizestheAlamedaCountyHealthCareServiceAgency’sJuvenileJusticeHealthServicesoranotherdesigneetoperformahealthassessmentforyouthconfinedinacountydetentionfacility.21Alloftheseordersandruleslimitthehealthassessmenttocertainservicesandestablishparametersforattemptingtoobtainparentconsent.

• Certaincarerequiresacourtorder:forexample,acourtorderisnecessarywhen

wardsneedinpatientpsychiatrichospitalization.Seesection(E)belowformoredetail.

3. CaregiversAwardnotplacedinajuvenileinstitutionmaybeplacedinoneofseverallivingsituations.Ifawardisplacedwithafosterparentorothercaregiver,theward’scaregivermayprovideconsentfortheminor’smedicaltreatmentinthefollowingsituations:

• Alicensedcaregiverprovidingresidentialfostercaremaygiveconsentfor

ordinarymedicalanddentaltreatment,includingbutnotlimitedtoimmunizations,physicalexams,andX‐rays.Cal.Health&Saf.Code§1530.6.22Thecaregiverdoesnotneedacourtordertobeabletoauthorizethiscare.Ordinarymedicalcaredoesnotincludementalhealthtreatmentorpsychotropicmedications.Seesection(E)for“mentalhealth”and“medication”consentrules.

• Beyondordinarycare,thecourtmayauthorizearelativecaregivertoprovidethe

samelegalconsentfortheminor’smedical,surgical,anddentalcareasthecustodialparentofaminorifthechildhasbeenplacedintheapprovedhomeofarelative.Cal.Welf.&Inst.Code§727(a)(1).23

4. TheDepartmentofCorrectionsandDepartmentofJuvenileJustice

TheDepartmentofCorrectionsandDepartmentofJuvenileJusticemayauthorizenecessarymedical,surgicalordentalcareifaminorisunderthejurisdictionofsaiddepartment,andan

20SantaClaraJuv.Ct.R.1(K).21 AlamedaStandingOrderNo.2007‐06.22Cal.Health&Saf.Code§1530.6(“Notwithstandinganyotherprovisionoflaw,personslicensedpursuanttothischaptertoprovideresidentialfostercaretoachildeitherplacedwiththempursuanttoanorderofthejuvenilecourtorvoluntarilyplacedwiththembythepersonorpersonshavinglegalcustodyofsuchchild,maygivethesamelegalconsentforthatchildasaparentexceptforthefollowing:(1)marriage;(2)entryintothearmedforces;(3)medicalanddentaltreatment,exceptthatconsentmaybegivenforordinarymedicalanddentaltreatmentforsuchchild,including,butnotlimitedto,immunizations,physicalexaminations,andX‐rays;and(4)ifthechildisvoluntarilyplacedbytheparentorparents,thoseitemsasareagreedtoinwritingbythepartiestotheplacement.Tothiseffect,thestatedepartmentshallprescriberulesandregulationstocarryouttheintentofthissection.Thissectiondoesnotapplytoanysituationinwhichajuvenilecourtorderexpresslyreservestherighttoconsenttothoseactivitiestothecourt.”).23WIC§727(a)(1)(“…Whenadecisionhasbeenmadetoplacetheminorinthehomeofarelative,thecourtmayauthorizetherelativetogivelegalconsentfortheminor'smedical,surgical,anddentalcareandeducationasiftherelativecaretakerwerethecustodialparentoftheminor.”).

attendingphysicianordentisthasrecommendedthecare.Cal.Welf.&Inst.Code§1755.3.24However,aminorunderDJJjurisdictionmayrefusetherecommendedcare.Inonlyafewsituationsmaytreatmentbeprovidedovertheminor’sobjection.59Ops.Cal.Atty.Gen402,411(1976).25Seesection(D)belowformoreontreatmentforyouthindetentionfacilities.

C. ConsentRulesinSpecialCircumstancesInadditiontowhoeverholdsprimaryconsentrights,othersmayconsenttoahealthcareforaminorunderthejurisdictionofthejuvenilecourtinthesespecialsituations:1. EmergencyCare

Inadditiontowhoeverholdsprimaryconsentrights,thefollowingmayconsentforcareinanemergency26:

• Theprobationofficermayauthorizenecessarymedicalcareinanemergency;however,beforeprovidingauthorization,theofficermustmakereasonableeffortsto“obtaintheconsentof,ortonotify,theparent,guardianorpersonstandinginlocoparentispriortoauthorizingcare.”Cal.Welf.&Inst.Code§739(d).27Eveniftheparentorguardianrefusestogiveconsent,though,theprobationofficermayproceed.Acourtorderisnotnecessary.

• Alternatively,thecourtmayprovidetherequisiteauthorizationfortreatmentifa

licensedphysician,surgeon,ordentisthasrecommendedthetreatment,andtheminor’sparentorguardian,ifthereisone,hasreceivedduenotice.Cal.Welf.&Inst.Code§739(b).28

24WIC§1755.3(“WheneveranypersonunderthejurisdictionoftheYouthAuthority,oranyminorunderthejurisdictionoftheDepartmentofCorrections,isinneedofmedical,surgical,ordentalcare,theYouthAuthorityortheDepartmentofCorrections,asapplicable,mayauthorize,upontherecommendationoftheattendingphysicianordentist,asapplicable,theperformanceofthatnecessarymedical,surgicalordentalcare.”).2559Ops.Cal.Atty.Gen.402,411(1976)(“Thetreatmentmaybecompelledagainsttheminor’sobjectionsifnecessarytopreventtheminor’s“…deathorseriousphysicaldisability,ortofurtheracompellinginterestof[DJJ]…”Also,inthecaseofnon‐criticalillnessorinjury,medicaltreatmentoftheminormaybecompelledovertheminor’sobjectionif“…intheprofessionalopinionofthemedicalstaff,therewouldbeanunwarrantedrisktothechildifthetreatmentisnotbegunatonce…”Thequestionofwhethertreatmentshouldcontinuenotwithstandingtheminor’sobjectioncanthenberesolved.”).

26WIC§739(d)(“‘Emergencysituation,’forthepurposesofthissubdivisionmeansaminorrequiresimmediatetreatmentforthealleviationofseverepainoranimmediatediagnosisandtreatmentofanunforeseeablemedical,surgical,dental,orotherremedialconditionorcontagiousdiseasewhichifnotimmediatelydiagnosedandtreated,wouldleadtoseriousdisabilityordeath.”).27WIC§739(d)(“Wheneveritappearsthataminor…requiresimmediateemergency,medical,surgical,orotherremedialcareinanemergencysituation,thatcaremaybeprovidedbyalicensedphysicianandsurgeon,oriftheminorneedsdentalcare…,byalicenseddentist,withoutacourtorderanduponauthorizationofaprobationofficer.…Theprobationofficershallmakereasonableeffortstoobtaintheconsentof,ortonotify,theparent,guardian,orpersonstandinginlocoparentispriortoauthorizingemergency…care...”).28WIC§739(b)(“Wheneveritappearstothejuvenilecourtthatanypersonconcerningwhomapetitionhasbeenfiledwiththecourtisinneedofmedical,surgical,dental,orotherremedialcare,andthatthereisnoparent,guardian,orpersonstandinginlocoparentiscapableofauthorizingorwillingtoauthorizetheremedialcareortreatmentforthatperson,thecourt,uponthewrittenrecommendationofalicensedphysicianandsurgeonor,ifthepersonneedsdentalcare,alicenseddentist,andafterduenoticetotheparent,guardian,orpersonstandinginloco

• Iftheemergencyrequiresservicestowhichaminormustconsentonhisorher

ownunderfederalorstatelaw,suchastreatmentforanectopicpregnancy,theminormustconsenttothecareonhisorherownbehalf.Seesection(E)below“ConsentRulesforSpecialServices.”

• Ifamedicalproviderisunabletoobtainconsentinatimelymanner,heorshemay

providenecessaryemergencycarewithoutobtainingpriorconsent.Cal.Bus.&Prof.Code§2397(a).29

Inadditiontostatelaw,eachcountymayhaveitsownpolicyorprocedurethatmustbefollowedwhenobtainingemergencycareforaward.Pleaseseeyourlocalcourtrulesforguidance.

2. TemporaryCustody

Whenaminorisintemporarycustody30,aparent,guardianorotherpersonactinginlocoparentismayconsentforhealthcare,butinaddition:

• Aprobationofficermayconsenttotheprovisionofhealthservicesrecommended

byanattendingphysicianordentist.Beforeprovidingauthorization,however,theprobationofficermustnotifytheparent,guardianorpersonstandinginlocoparentisoftheneedforhealthservices.Ifthispersonobjectstothetreatment,theminormaynotreceivecarewithoutacourtorderauthorizingtreatment.Cal.Welf.&Inst.Code§739(a).31

parentis,ifany,maymakeanorderauthorizingtheperformanceofthenecessarymedical,surgical,dental,orotherremedialcareforthatperson.”).29Cal.Bus.&Prof.Code§2397(a)(“Alicenseeshallnotbeliableforcivildamagesforinjuryordeathcausedinanemergencysituationoccurringinthelicensee'sofficeorinahospitalonaccountofafailuretoinformapatientofthepossibleconsequencesofamedicalprocedurewherethefailuretoinformiscausedbyanyofthefollowing:[...]Amedicalprocedurewasperformedonapersonlegallyincapableofgivingconsent,andthelicenseereasonablybelievedthatamedicalprocedureshouldbeundertakenimmediatelyandthattherewasinsufficienttimetoobtaintheinformedconsentofapersonauthorizedtogivesuchconsentforthepatient.”).30WIC§729(a);§625(“Apeaceofficermay,withoutawarrant,takeintotemporarycustodyaminor:(a)Whoisundertheageof18yearswhensuchofficerhasreasonablecauseforbelievingthatsuchminorisapersondescribedinSection601or602,or(b)WhoisawardofthejuvenilecourtorconcerningwhomanorderhasbeenmadeunderSection636or702,whensuchofficerhasreasonablecauseforbelievingthatpersonhasviolatedanorderofthejuvenilecourtorhasescapedformanycommitmentorderedbythejuvenilecourt,or(c)Whoisundertheageof18yearsandwhoisfoundinanystreetorpublicplacesufferingfromanysicknessorinjurywhichrequirescare,medicaltreatment,hospitalization,orotherremedialcare.”).WIC§626.6(“Anypeaceofficerwhotakesaminorwhois14yearsofageorolderintotemporarycustodyundersection625.3shalltaketheminorwithoutunnecessarydelaybeforetheprobationofficer…anddeliverthecustodyoftheminortotheprobationofficer….”).WIC§627(a)(“Whenanofficertakesaminorbeforeaprobationofficeratajuvenilehallortoanyotherplaceofconfinementpursuanttothisarticle,heshalltakeimmediatestepstonotifytheminor’sparent,guardian,oraresponsiblerelativethatsuchminorisincustodyandtheplacewhereheisbeingheld.”).WIC§632(detentionhearinginfrontofjudgemustoccurwithinonejudicialdayorinsomecases,within48hours.)31WIC§739(a)(“iftheparent,guardian,orpersonstandinginlocoparentisobjects,thecareshallbegivenonlyuponorderofthecourtintheexerciseofitsdiscretion.”).

• Thecourtmayauthorizehealthcareservicesifalicensedphysician,surgeon,ordentistrecommendstreatment;duenoticeisgiventotheminor’sparentorguardian;andthejuvenilecourtfindsthatnoparent,guardianorpersonstandinginlocoparentisiswillingandabletoprovideconsent.Cal.Welf.&Inst.Code§739(b).32Insomecounties,thecourtshaveissuedstandingcourtordersauthorizingcertainhealthcareproviderstodeliverspecificservicestominorsintemporarycustody.Forexample,astandingorderinAlamedacountyallowstheCountyHealthCareAgencyoritsdesigneetoprovideahealthassessmenttoyouthwhohavebeenretainedinanytypeofcountyfacility,butwhohavenothadtheirfirstdetentionhearing.33

3. TreatmentasaConditionofProbation

Whenthecourtplacesaminoronprobation,thecourt“mayimposeonthewardanyandallreasonableconditionsofbehaviorasmaybeappropriateunderthisdisposition.”Cal.Welf.&Inst.Code§727(a).Insomecases,courtshaveorderedorconditionedprobationonattendingmentalhealthcounseling.34Inothers,courtshavemadedrugtestingandattendingsubstanceabusetreatmentaprobationcondition.Forexample,ifthecourtdoesnotremoveaminorfromhisorherparents’physicalcustody,thecourtmayrequireasaconditionofprobationthattheminorsubmittourinealcoholanddrugtestingupontherequestofapeaceorprobationofficer.Cal.Welf.&Inst.Code§729.3.Similarly,thecourtmayrequiretheminorparticipatein,andcomplete,analcoholordrugeducationprogram.SeeCal.Welf.&Inst.Code§§729.10;729.12.35However,thisordermakingcounseling,testingorothertreatmentaconditionofprobationisnotthesameasauthorizingorconsentingtoservices.Consentisstillnecessarytoprovidetreatment,andiftheminor’sconsentisnecessarytoprovidethattreatment,theminormayrefuse.However,whileaminormayrefusetoconsenttoorchoosenottoattendtreatment,theremaybeconsequences.Forexample,inonecase,award’srefusaltoparticipateincourt‐ordereddrugtreatmentbecamethebasisforthecourt’sdecisiontocommitthewardtoaYouthAuthorityfacility.InreAnthonyM.,172Cal.Rptr.153,161(Cal.App5thDist.,1981).Ifminorshaveconcernsaboutanycourt‐orderedtreatment,

32WIC§739(b)(“Wheneveritappearstothejuvenilecourtthatanypersonconcerningwhomapetitionhasbeenfiledwiththecourtisinneedofmedical,surgical,dental,orotherremedialcare,andthatthereisnoparent,guardian,orpersonstandinginlocoparentiscapableofauthorizingorwillingtoauthorizetheremedialcareortreatmentforthatperson,thecourt,uponthewrittenrecommendationofalicensedphysicianandsurgeonor,ifthepersonneedsdentalcare,alicenseddentist,andafterduenoticetotheparent,guardian,orpersonstandinginlocoparentis,ifany,maymakeanorderauthorizingtheperformanceofthenecessarymedical,surgical,dental,orotherremedialcareforthatperson.”) 33SeeAlamedaCountyStandingOrderNo.2007‐06.34Forexample,thecourtmayorderawardandhisorherfamilyto“participateinaprogramofprofessionalcounseling….”Cal.Welf.&Inst.Code§731(a).35WIC§729.10(a)(“Whenever,inanycountyspecifiedinsubdivision(b),ajudgeofajuvenilecourtorrefereeofajuvenilecourtfindsaminortobeapersondescribedinSection602byreasonofthecommissionofanoffenseinvolvingtheunlawfulpossession,use,sale,orotherfurnishingofacontrolledsubstance,…theminorshallberequiredtoparticipatein,andsuccessfullycomplete,analcoholordrugeducationprogram,orbothofthoseprograms,asdesignatedbythecourt…theexpenseoftheperson’sattendanceintheprogramshallbepaidbytheperson’sparentsorguardiansolongasthepersonisundertheageof18years….(b)Thissectionappliesonlyinthosecountiesthathaveoneormorealcoholordrugeducationprogramscertifiedbythecountyalcoholprogramadministratorandapprovedbytheboardofsupervisors.”).

theyshoulddiscusstheseconcernswiththeirpublicdefenderoranothertrustedadvocate.

D.ConsentandAccessRuleswhenMinorisinaCountyFacility

Asageneralrule,thesameconsentrulescitedinsectionsA,B,andCapplywhenservicesareprovidedwithinacountyjuvenilefacility36.Thus,ifparentconsentnormallywouldberequiredoutsidethefacility,parentconsentisalsorequiredinsidethefacility,andifaminor’sconsentisnecessarytoprovideaparticularserviceoutsidethefacility,aminor’sconsentisnecessaryinside.37However,therearesomespecialrulesandrightsthatgettriggeredwhenminorsenteracountyjuvenilefacility,asfollows:

1. RightstoSpecificServicesandConsentRuleswhileDetained/Committed

Specialrulesapplywhenminorsincountyfacilitiesneedorreceivethefollowingservices.Seetherelatedsectionsunder(E)belowfordetails.

• “HIV/AIDStestingandtreatment”• “Infectious,reportable,communicablediseases”• “Reproductivehealthservices”• “MentalHealth:PsychotropicMedications”• “SexualAssault”

2. RighttoHealthCareandScreens

Whenyouthareinvoluntarilyconfinedbythestateorcounty,thatinstitutionhasaresponsibilitytoensuretheyreceiveadequatemedicalservices.38Statelawsandregulationsspecificallyprovidethatminorsinstateandcountycustodyhavearighttocertainheathcare.39Thisincludesarighttoahealthscreenandhealthevaluation.Immediatelyafteraminorentersacountyjuveniledetentionfacility,thefacilitymustconductamedicalhealthscreening.40Thescreeningservestwofunctions:Toidentifyanymedicalconditionsthatwouldneedtreatmentduringtheminor’sdetentionandto

36Thefollowingfocusesontheruleswhenminorsaredetainedincountyjuvenilefacilities.Inafewplaces,itnotesrelatedrulesforminorsinDJJfacilities,butitisnotintendedasacompletereviewofthelawsrelatedtomedicaltreatmentforyouthinDJJfacilities.3715CCR§1434(b)(“Thereshallbeprovisionforobtainingparentalconsentandobtainingauthorizationforhealthcareservicesfromthecourtwhenthereisnoparent/guardianorotherpersonstandinginlocoparentis.”;15CCR§1434(c)“Policyandproceduresshallbeconsistentwithapplicablestatutesinthoseinstanceswheretheminor'sconsentfortestingortreatmentissufficientorspecificallyrequired.”).38Estellev.Gamble,429U.S.97(1976)(EighthAmendmenttotheU.S.Constitutionobligatesprisonstoensureprisonersreceiveadequatehealthcare);59Ops.Cal.Atty.Gen.402,406(1976).39Seee.g.Cal.Welf.&Inst.Code§§210,885;15CCR§1400.Seealso15CCR§1400(facilityadministratorofjuvenilefacility“shallensurethathealthcareservicesareprovidedtoallminors.”);15CCR§1200(facilityadministratorofTypeI,II,IIIandIVlocaladultdetentionfacilitieshasresponsibilitytoensureprovisionofemergencyandbasichealthcareservicestoallinmates);15CCR§§4611,4730(DJJdiagnosticandtreatmentservices).4015CCR§1430(b)(“The[health]screeningshallbeconductedimmediatelyuponentrytothefacility.”).

findoutwhethertheminorhasanyhealthconditionsthatcould“poseahazard”totheminororanyoneelseatthefacility.41Inaddition,minorsalsohavearighttoahealthevaluationwithin96hoursoftheiradmission.42Ataminimum,theevaluationmustincludea“healthhistory,examination,laboratoryanddiagnostictesting,andnecessaryimmunizations.”43Similartothehealthscreening,ahealthevaluationcouldincludeaninvestigationforawiderangeofailments.Examinationscouldincludeabloodpressuretest,chestexam,andpelvicexamination.44Laboratorytestingcouldincludetestsfortuberculosis,STDs,andpregnancy.45Boththehealthscreenandhealthevaluationrequireconsent.Theyouth’sconsentmaybenecessaryforcertainscreensandexams,andtheparent’sconsentforothers.Seesection(E)belowforminorconsentrules.Becauseparentsmaybedifficulttolocateandconsentdifficulttoobtainwithin96hours,somecountieshaveadoptedspecialprotocolsandstandingcourtordersregardingconsentforscreeningandevaluationtoensurethesescreensandexamsoccurinatimelymanner.Forexample,SanFrancisco’sJuvenileCourthasadoptedastandingorderthatauthorizesroutinemedicalcaredeliveryforyouthforthefirstthreedaysyouthareintemporarycustodyifconsentcannotbeobtainedfromaparent.46SanDiegoCountyhasadoptedaspecialcourtrule.47Seeyourlocalcourtrulesandstandingordersforguidance.

3. RighttoRefuseTreatmentwhileDetained/Committed

Minorsincountyjuvenilefacilitieshavetherighttorefusenon‐emergencyhealthcare.15Cal.CodeRegs.§1434.48Theyalsohavetherighttorefusepsychotropicmedicationinmostsituations.Seesection(E):“MentalHealth:PsychotropicMedications”below.MinorsinthecustodyofDJJalsohavearighttorefusetreatment;however,thefacilitymaycompeltreatmentincertainsituationsasfollows.Ifaminorortheminor’sparentorguardianrefusestreatment,“[t]he[DJJ]physicianordentistshallexplaintheconsequencesoftherefusaltothewardoraparentorguardianifthewardisunder18

4115CCR§1430(b)(1)4215CCR§1432(a)(“Thehealthappraisal/medicalexaminationshallbecompletedwithin96hoursofadmissiontothefacilityandresultinacompilationofidentifiedproblemstobeconsideredinclassification,treatment,andthemulti‐disciplinarymanagementoftheminorwhileincustodyandinpre‐releaseplanning.”).SeealsoWIC§1004;15CCR§4732(evaluationsforwardsinDYAcustody);15CCR§1123(minorsinadultjails).4315CCR§1432.4415CCR§1432(a)(1)(B).4515CCR§1432(a)(1)(C).46SanFranciscoJuvenileCourtStandingOrderNo.306(“Underthisorderthecourtauthorizesroutinemedicalordentalcare,(excludingsurgery,non‐routinetreatmentsandprescribingofmedications)ofallminorsduringthefirstthree(3)workingdaysfollowingdetentionoftheseminorsintemporarycustody,ifsuchauthorizationcannotfirstbeobtainedfromtheminor’sparentand/orlegalguardian.”).47 SanDiegoCt.R.6.9.13(“PriormedicalauthorizationwillnotberequiredfortheinitialhealthscreeningofminorsatKearnyMesaJuvenileDetentionFacilityand/orEastMesaJuvenileDetentionFacility.Initialhealthscreeningsmustbeperformedwithin96hoursofdetentionandwillincludeaphysicalexamination,laboratorytests,immunizations,andX‐rays.TheProbationDepartmentwillattempttoobtainparentalconsentformedicalcare.Ifsuchconsentcannotbeobtained,theProbationDepartmentwillseekacourtorderauthorizingmedicalcare.Inanemergencysituation,medicalcaremaybedeliveredtominorsindetentionwithoutparentalconsentoracourtorder.”). 4815CCR§1434(“Minorsmayrefuse,verballyorinwriting,non‐emergencymedicalandmentalhealthcare.”).

andrecordtherefusalinthemedicalrecord,includingastatementofthepossibleconsequencesifthemedical,surgical,mentaland/ordentaltreatmentisnotadministered.”15CCR§4734.Atthatpoint,treatmentauthorizationmaybesoughtfromthecourtifcertainconditionsaremet.15CCR§4735.49AuthorizationtoadministerpsychotropicmedicationinaDJJfacilityabsentconsentmustfollowtherulesinsection4747ofchapter15oftheAdministrativeCode.SeealsoSection(B)above.

E. ConsentRulesforSpecialServicesFederalandstatelawgrantsminorstherighttoconsenttocertaintypesofhealthcareontheirownaccord.Theserightsdonotchangewhenaminorbecomesawardofthecourt.Seee.g.15CCR§1434(c).Thissectionreviewsthoserightsastheyapplyinthedelinquencycontext.Thesectionalsoreviewsspecialconsentrulesthatapplywhenwardsneedcertainotherhealthcare.

1. DiagnosingChildAbuse

AhealthcareprovidermaytakeskeletalX‐raysofachildwithouttheconsentofthechild’sparentorguardian,butonlyforpurposesofdiagnosingthecaseasoneofpossiblechildabuseorneglectanddeterminingtheextentofthechildabuseorneglect.Cal.PenalCode§11171.2(a).50

2. HIV/AIDS:TestingandTreatment

Whenaminoris12yearsoldorolder,theminor’sconsentisnecessarytotestortreatforHIV.Cal.FamilyCode§6926(a).51Thisholdstrueforminorsinvolvedinthejuvenilejusticesystemaswell.See15CCR§1434.52Forminorslessthan12yearsofage,theconsentrulesdescribedinsectionsA,BandC,above,apply.Undersomecircumstances,however,minorsunderthejurisdictionofthejuvenilecourtmaybeobligatedtosubmittotestingforHIVwithouttheirconsent.Forexample,minorsmaybeobligatedtosubmittoatest:

4915CCR§4735(“(a)Authorizationmaybesoughtfromacourttocompelnecessarymedicaland/ordentaltreatmentforaward18yearsofageorolderorforawardunder18,whenaparentorguardianrefusestoconsentor isnotavailableif:(1)Intheprofessionalopinionofthetreatingphysician,thetreatmentisimmediatelynecessaryforthepreventionofdeathorseverephysicaldisability totheward inquestion,or (2) In theopinionof thechiefmedicalofficer and the chiefof thehealth care servicesdivision, therewouldbea resultantdanger to thewelfareand/orsafetyoftheinstitutionand/orstafforwardsasaresultoftherefusal.(b)Medicalordentaltreatment,asdefinedinsubsection(a)(1)and(a)(2)maybeinitiatedimmediatelyandcontinuedpendingresolutionbythecourt.”).50Cal.Pen.Code§11171.2(a)(“(a)AphysicianandsurgeonordentistortheiragentsandbytheirdirectionmaytakeskeletalX‐raysofthechildwithouttheconsentofthechild'sparentorguardian,butonlyforpurposesofdiagnosingthecaseasoneofpossiblechildabuseorneglectanddeterminingtheextentofthechildabuseorneglect.”).51Cal.Fam.Code§6926(a)(“Aminorwhois12yearsofageorolderandwhomayhavecomeintocontactwithaninfectious,contagious,orcommunicablediseasemayconsenttomedicalcarerelatedtothediagnosisortreatmentofthedisease,ifthediseaseorconditionisonethatisrequiredbylaworregulationadoptedpursuanttolawtobereportedtothelocalhealthofficer,orisarelatedsexuallytransmitteddisease,asmaybedeterminedbytheStateDirectorofHealthServices.”).5215CCR§1434(a)(“Allexaminations,treatments,andproceduresrequiringverbalorwritteninformedconsentinthecommunityalsorequirethatconsentforconfinedminors.”(c)“Policyandproceduresshallbeconsistentwithapplicablestatutesinthoseinstanceswheretheminor'sconsentfortestingortreatmentissufficientorspecificallyrequired.”).

• IfthemedicalofficerataDJJfacilitydeterminesthatapersonunderDJJ

jurisdictionexhibitsclinicalsymptomsofAIDSorAIDS‐relatedcomplex.Cal.Welf.&Inst.Code§1768.9(a).

• Ifalawenforcementemployeeorafellowinmatebelievesheorshemayhavecomeintocontactwiththebodilyfluidsofaninmate,orapersonarrestedordetainedfororchargedwithanoffenseforwhichheorshemaybemadeawardofthecourtunderSection602,theemployeeorinmatemayrequestthechiefmedicalofficerofthefacilitytorequireHIVtestingofsuchperson.Cal.PenalCode§§7510;7512.

• Ifavictimofspecificsexualcrimesrequeststesting,baseduponafindingofprobablecausetobelievethatatransferofbodilyfluidsoccurred.Cal.Health&SafetyCode§121055.

• Ifapeaceofficer,firefighteroremergencymedicaltechnicianrequeststestingofanarrestee,uponafindingofprobablecause.Cal.Health&SafetyCode§121060.

3. Infectious,ContagiousorCommunicableDiseases:TestingandTreatment

Allyouth12yearsoldandolder,includingyouthinthejuvenilejusticesystem,whomayhavecomeintocontactwithaninfectious,contagious,orcommunicablediseasemayconsenttomedicalcarerelatedtothediagnosisortreatmentofthedisease,ifthediseaseorconditionisonethatisrequiredbylaworregulationadoptedpursuanttolawtobereportedtothelocalhealthofficer,orisarelatedsexuallytransmitteddisease,asmaybedeterminedbytheStateDirectorofHealthServices.Cal.FamilyCode§6926(a).53See15CCR§1434.54Reportablecommunicablediseasesincludetuberculosis;hepatitisA,B,CandD;lymedisease;andpertussis,amongothers.See17CCR§§2500,2641‐2643foracompletelist.

Foryouthlessthan12yearsofage,theconsentrulesdescribedinsectionsA,BandC,above,apply.Undersomecircumstances,wardscommittedtoadetentionfacilitymaybeobligatedtosubmittotestingforcertaininfectiousorcommunicablediseases.Forexample,themedicaldirectorofaDepartmentofCorrectionsoraDJJinstitutionhastheauthoritytorequiretestingofincarceratedwardsforcontagiousdiseases.Cal.Health&SafetyCode§1250.4(c),(f)&(g).55AnInstitution’sabilitytotestforHIVandTBwithoutpatientconsent

53Cal.FamilyCode§6926(a).5415CCR§1434(a)(“Allexaminations,treatments,andproceduresrequiringverbalorwritteninformedconsentinthecommunityalsorequirethatconsentforconfinedminors.”(c)“Policyandproceduresshallbeconsistentwithapplicablestatutesinthoseinstanceswheretheminor'sconsentfortestingortreatmentissufficientorspecificallyrequired.”).55Cal.Health&SafetyCode§1250.4(c)(“Themedicaldirector,chiefofmedicalservices,chiefmedicalofficer,orthephysiciandesignatedbythedepartmenttoactinthatcapacity,shalluseeveryavailablemeanstoascertaintheexistenceof,andtoimmediatelyinvestigate,allreportedorsuspectedcasesofanycommunicable,contagious,orinfectiousdiseaseandtoascertainthesourceorsourcesoftheinfectionsandpreventthespreadofthedisease.Incarryingouttheseinvestigations,themedicaldirector,chiefofmedicalservices,chiefmedicalofficer,orthephysiciandesignatedbythedepartmenttoactinthatcapacity,isherebyinvestedwithfullpowersofinspection,examination,andquarantineorisolationofallinmatesorwardsknowntobe,orreasonablysuspectedtobe,infectedwithacommunicable,contagious,orinfectiousdisease.”).

areaddressedinadifferentseriesofstatutes–sections7500etseq.and7570etseq.ofthePenalCode.See“HIVTesting”aboveformore.Ifawardinastateorcountyfacilityisfoundtobeinfectedwithcertaincontagiousorcommunicablediseases,furtherrulesmayapplyregardinghousing.Seee.g.Cal.Welf.&Inst.Code§733.56

4. MentalHealth:AssessmentandCounseling(Outpatient)

Youth12yearsoldandolder,includingyouthinvolvedinthejuvenilejusticesystem,mayconsentforoutpatientmentalhealthtreatmentandcounselingifbothofthefollowingrequirementsaresatisfied:1. Theminor,intheopinionoftheattendingprofessionalperson,ismatureenoughto

participateintelligentlyintheoutpatientservices: and2. Theminor(a)wouldpresentadangerofseriousphysicalormentalharmtoselforto

otherswithoutthementalhealthtreatmentorcounselingorresidentialshelterservices,or(b)istheallegedvictimofincestorchildabuse.

Cal.FamilyCode§6924(b).57

Ifayouthunderthejurisdictionofthejuvenilecourtdoesnotmeettherequirementsdescribedabove,theconsentrulesdescribedinsectionsA,BandC,above,apply,withonecaveat.Insomecases,inadditiontoconsentfromtheparentorotherqualifiedpersonasoutlinedabove,theprovideralsomayneedconsentfromthewardbeforecertainoutpatientmentalhealthcarecanbeprovided.58Forexample,ifthecourtrefersaminorforasection712mentalhealthevaluation,theminor,withapprovalofhisorhercounsel,hastherighttodeclinethereferral.Cal.Welf&Inst.Code§§711,712.Clinicianswhoworkwithyouthinvolvedinthejuvenilejusticesystemshouldspeaktotheirownlegalcounselforfurtherinformationonwhenminorconsentmaybenecessary.Evenwhenaminor’sconsentisnotlegallynecessary,seekingtheminor’sassenttocounselingcanbehelpfulfortherapeuticpurposes.Apatientmustbeawillingparticipantintreatmentformentalhealthcounselingtobefruitful.Ifawardisreluctanttoparticipateincounseling,thentheminor’sparent,provider,probationofficer,attorneyorothers,asappropriate,shouldworktoidentifyandattempttoalleviatetheminor’sconcerns,orrespecthisorherdecision.

56Cal.Welf.&Inst.Code§733"AwardofthejuvenilecourtwhomeetsanyconditiondescribedbelowshallnotbecommittedtotheDepartmentofCorrectionsandRehabilitation,DivisionofJuvenileFacilities:…(b)Thewardissufferingfromanycontagious,infectious,orotherdiseasethatwouldprobablyendangerthelivesorhealthoftheotherinmatesofanyfacility.57Cal.Fam.Code§6924(b)(“Aminorwhois12yearsofageoroldermayconsenttomentalhealthtreatmentorcounselingonanoutpatientbasis,ortoresidentialshelterservices,ifbothofthefollowingrequirementsaresatisfied:(1)Theminor,intheopinionoftheattendingprofessionalperson,ismatureenoughtoparticipateintelligentlyintheoutpatientservicesorresidentialshelterservices.(2)Theminor(A)wouldpresentadangerofseriousphysicalormentalharmtoselfortootherswithoutthementalhealthtreatmentorcounselingorresidentialshelterservices,or(B)istheallegedvictimofincestorchildabuse.”).

58Forexample,servicesunderWIC§6552requireaminor’sapplicationtoinitiate.

Somecountieshaveimplementedstandingcourtordersandprotocolstohelpensurethementalhealthneedsofyouthundercourtjurisdictionarebeingaddressedassoonaspossible.59Seeyourlocalcourtrulesandagencyprotocolsforguidance.Informationonmentalhealthcounselingasaconditionofprobationisdiscussedaboveinsection(C)(3).

5. MentalHealth:InpatientHospitalization

Award’sconsentisnecessarybeforetheminormaybehospitalizedformentalhealthtreatmentinallbutafewcircumstances.Beforeadelinquentminormaybehospitalizedasavoluntarypatient,theminor,inconsultationwithhisorherattorney,mustmakeanapplicationforvoluntaryhospitalization.Thecourtthenmustapprovetheapplication.Thecourt“mayauthorizetheminortomakesuchapplicationifitissatisfiedfromtheevidencebeforeitthattheminorsuffersfromamentaldisorderwhichmayreasonablybeexpectedtobecuredoramelioratedbyacourseoftreatmentofferedbythehospital,facilityorprograminwhichtheminorwishestobeplaced;andthatthereisnootheravailablehospital,program,orfacilitywhichmightbetterservetheminor’smedicalneedsandbestinterest.”Cal.Welf.&Inst.Code§6552.60

Inverylimitedcircumstances,awardmaybeadmittedtoapsychiatrichospitalagainsttheminor’swishesasaninvoluntarypatient.Ifthecourtbelieves,beforeorduringahearingonthedelinquencypetition,thattheminorismentallydisorderedormaybementallyill,thecourtmayproceedundersection6550oftheWelfareandInstitutionsCodeorsection4011.6ofthePenalCode.Cal.Welf.&Inst.Code705.61TheproceduresunderCal.Welf.&Inst.Code§6550andPenalCode§4011.6areslightlydifferent,but“…shouldbeconsideredcomplimentary,ratherthanasprovidingalternativeprocedures.”InreRobertB.,46Cal.Rptr.2d691,694(1995).Bothlawsprovidethatwhenitappearstoajudgethatawardmaybementallydisordered,thejudgemayorderthewardtobetakentoan

59Forexample,SanFranciscoCountyhasimplementedastandingorderthatgives“membersoftheFosterCareMentalHealthUnit”theauthoritytoexecutedocuments“necessaryforthe[mentalhealth]assessmentandtreatment”ofdependentsandminorswhosedependencystatusispendingbeforethecourt.TheUnitisauthorizedtoexecutethesedocumentsinallcasesinwhichtheminor’sparentorguardianisunavailable,unable,orunwillingtoexecutesuchdocumentsthemselves.SanFranciscoCountyJuvenileCourtStandingOrderNumber203‐“AuthorizationforMentalHealthTreatment”.

60WIC§6552(“Aminorwhohasbeendeclaredtobewithinthejurisdictionofthejuvenilecourtmay,withtheadviceofcounsel,makevoluntaryapplicationforinpatientoroutpatientmentalhealthservicesinaccordancewithSection5003.Notwithstandingtheprovisionsofsubdivision(b)ofSection6000,Section6002,orSection6004,thejuvenilecourtmayauthorizetheminortomakesuchapplicationif it issatisfiedfromtheevidencebeforeitthattheminorsuffers from a mental disorder which may reasonably be expected to be cured or ameliorated by a course oftreatmentofferedbythehospital, facilityorprograminwhichtheminorwishestobeplaced;andthatthere isnootheravailablehospital,program,or facilitywhichmightbetterservetheminor'smedicalneedsandbest interest.Thesuperintendentorpersoninchargeofanystate,county,orotherhospitalfacilityorprogrammaythenreceivetheminorasavoluntarypatient.Applicationsandplacementsunder thissectionshallbesubject to theprovisionsand requirementsof theShort‐DoyleAct (Part2 (commencingwithSection5600),Division5),whicharegenerallyapplicabletovoluntaryadmissions.”).61WIC§705(“Wheneverthecourt,beforeorduringthehearingonthepetition,isoftheopinionthattheminorismentallydisorderedorifthecourtisindoubtconcerningthementalhealthofanysuchperson,thecourtmayproceedasprovidedinSection6550ofthiscodeorSection4011.6ofthePenalCode.”).

approvedfacilityfor72‐hourtreatmentandevaluationpursuanttoCal.Welf.&Inst.Code§5150.Ofcourse,atanytime,thecourtalsomayorderawardheldfor72‐hourtreatmentandevaluationifitappearstheminor,asaresultofmentaldisorder,isadangertohimorherselforothers,orgravelydisabled.Cal.Welf.&Inst.Code§5150.62Forthispurposeonly,"gravelydisabled"isdefinedinsection5585.2563oftheWelfareandInstitutionsCode.Cal.Welf.&Inst.Code§5585.20.Afterthecompletionof72hours,iftheprofessionalpersoninchargeofthefacilityfindsthat,astheresultofmentaldisorder,theminorisinneedofintensivetreatmentandcertainothercriteriaaremet,theminormaybe‘certified’fornotmorethan14daysofadditionalinvoluntarytreatment.Cal.Welf.&Inst.Code§5250.However,theminordoeshavearighttonoticeandahearingbeforetheminorcanbecertifiedforthisadditionaltreatment.Cal.Welf.&Inst.Code§5252etseq.Attheendofthe14‐dayperiod,theprofessionalinchargeofthefacilitymayrecommendanadditionalstayofnomorethan30days.Inafewcircumstances,theprofessionalinchargemaybeabletorecommendanadditionalstayofnomorethan180days.Again,theminorhasarighttonoticeandahearingbeforethisadditionalinvoluntarytreatmentcanoccur.Seee.g.Cal.Welf.&Inst.Code§§5260,5270.15,5300.Beyondthis,furtherinvoluntarytreatmentrequiressignificantdueprocesstoinitiate,butitisavailableifthecourtdeterminestheminoris“gravelydisabled.”64Forthispurpose,“gravelydisabled”meanstheyouthcannotprovideforhisorherbasicpersonalneedsforfood,clothing,orshelter,or,thecourthasfoundtheyouthtobementallyincompetentpersection1370ofthePenalcodeandadditionalfactsexist.SeeCal.Welf.&Inst.Code§5008(h).65Inassessingwhetheraminoris“gravelydisabled”undersection5008,thecourtmustdistinguishbetweendisabilityandimmaturity:“Immaturity,eitherphysicalormentalwhennotbroughtaboutbyamentaldisorder,isnotadisabilitywhichwouldrenderaminor‘gravelydisabled’withinthemeaningofsection5008.”InreMichaelE.,15Cal.3d183,193(1977).

62WIC§5150(“Whenanyperson,asaresultofmentaldisorder,isadangertoothers,ortohimselforherself,orgravelydisabled,apeaceofficer,memberoftheattendingstaff,asdefinedbyregulation,ofanevaluationfacilitydesignatedbythecounty,designatedmembersofamobilecrisisteamprovidedbySection5651.7,orotherprofessionalpersondesignatedbythecountymay,uponprobablecause,take,orcausetobetaken,thepersonintocustodyandplacehimorherinafacilitydesignatedbythecountyandapprovedbytheStateDepartmentofMentalHealthasafacilityfor72‐hourtreatmentandevaluation.”).63WIC§5585.25(“‘Gravelydisabledminor’”meansaminorwho,asaresultofamentaldisorder,isunabletousetheelementsoflifewhichareessentialtohealth,safety,anddevelopment,includingfood,clothing,andshelter,eventhoughprovidedtotheminorbyothers.Mentalretardation,epilepsy,orotherdevelopmentaldisabilities,alcoholism,otherdrugabuse,orrepeatedantisocialbehaviordonot,bythemselves,constituteamentaldisorder.”).64Cal.Welf.&Inst.Code§§6550,6551.SeeCal.Welf.&Inst.Code§§5150,5250,5270.15,5350.65WIC§5008(h)(“’Gravelydisabled’meanseitherofthefollowing:(A)Aconditioninwhichaperson,asaresultofamentaldisorder,isunabletoprovideforhisorherbasicpersonalneedsforfood,clothing,orshelter.or(B)Aconditioninwhichaperson,hasbeenfoundmentallyincompetentunderSection1370ofthePenalCodeandallofthefollowingfactsexist:(i)Theindictmentorinformationpendingagainstthedefendantatthetimeofcommitmentchargesafelonyinvolvingdeath,greatbodilyharm,oraseriousthreattothephysicalwell‐beingofanotherperson.(ii)Theindictmentorinformationhasnotbeendismissed.(iii)Asaresultofmentaldisorder,thepersonisunabletounderstandthenatureandpurposeoftheproceedingstakenagainsthimorherandtoassistcounselintheconductofhisorherdefenseinarationalmanner.”).

Thesamerulesapplywhenwardscommittedtoacountyfacilityneedinpatienttreatment.15C.C.R.§1437.Informationonuseofpsychotropicmedicationinaninpatientfacilityisbelowunderthesection“MentalHealth:PsychotropicMedication.”Specialprovisionsapplytominorsconfinedinstatecorrectionalschools.SeeCal.Welf.&Inst.Code§1756.66

Admittingaminorforinpatientmentalhealthtreatment,whetheritisvoluntaryorinvoluntarytreatment,involvesdetailedprocesses.Becausethissectiononlyprovidesasimpleoverviewoftheissue,providersshouldspeaktotheirowncounselformoreinformationandadviceonthespecificproceduresthatmustbefollowedtoadmitawardforinpatientmentalhealthcareintheircounty.Formoreonfosteryouthandmentalhealthservices,seeYouthLawCenter,MentalHealthServicesforFosterYouthinCalifornia,availableatwww.ylc.org.

6. MentalHealth:PsychotropicMedications

Unemancipatedminorscannotconsenttotheirownpsychotropicmedication.67Aparent,guardianorotherauthoritymustconsent.Whohasauthoritytoconsentwilldependinpartontheward’splacement.• WhenCourtAuthorizationisNecessaryIfawardremainsinthecustodyofhisorherparentorguardian,theparentorguardianhastherighttoconsentwhentheminorneedspsychotropicmedication,unlessthecourtspecificallyremovedthisright.SeeCal.Welf.&Inst.Code§§726(a);739(f).Ifawardhasbeenremovedfromparentalcustodyandplacedintofostercare,onlythejuvenilecourthastheauthoritytoconsenttotheadministrationofpsychotropicmedicationforthechildandmayonlydosouponaphysician’srequest.Thecourtmaydelegatethisauthoritytotheparentifitfindsthattheparentposesnodangertothechildandhastherequisitecapacity.Cal.Welf.&Inst.Code§739.5(a).68

66WIC§1756(“Notwithstandinganyotherprovisionoflaw,if,intheopinionoftheDirectoroftheYouthAuthority,therehabilitationofanymentallydisordered,ordevelopmentallydisabledpersonconfinedinastatecorrectionalschoolmaybeexpeditedbytreatmentatoneofthestatehospitalsunderthejurisdictionoftheStateDepartmentofMentalHealthortheStateDepartmentofDevelopmentalServices,theDirectoroftheYouthAuthorityshallcertifythatfacttothedirectoroftheappropriatedepartmentwhomayauthorizereceiptofthepersonatoneofthehospitalsforcareandtreatment.Uponnotificationfromthedirectorthatthepersonwillnolongerbenefitfromfurthercareandtreatmentinthestatehospital,theDirectoroftheYouthAuthorityshallimmediatelysendfor,take,andreceivethepersonbackintoastatecorrectionalschool.AnypersonplacedinastatehospitalunderthissectionwhoiscommittedtotheauthorityshallbereleasedfromthehospitaluponterminationofhisorhercommitmentunlessapetitionfordetentionofthatpersonisfiledundertheprovisionsofPart1(commencingwithSection5000)ofDivision5.”).67SeeCal.Fam.Code§6924(f).68WIC§739.5(a)(“IfaminorwhohasbeenadjudgedawardofthecourtunderSection601or602isremovedfromthephysicalcustodyoftheparentunderSection726andplacedintofostercare,asdefinedinSection727.4,onlyajuvenilecourtjudicialofficershallhaveauthoritytomakeordersregardingtheadministrationofpsychotropicmedicationsforthatminor.Thejuvenilecourtmayissueaspecific

Ifthewardhasbeenremovedfromparentcustodybutplacedincareotherthanfostercare,suchasjuvenilehall,thepersonwhoauthorizespsychotropicmedicationwilldependonlocalcourtrules.Asastartingpoint,thegeneralruleholds:theparentorguardianretainstherighttoconsent.However,thelocaljuvenilecourthastherighttoretainforitselfthepowertoauthorizepsychotropicmedicationforallwardswhoarenotinparentcustody.Cal.R.Ct.5.640.69Somecounties,suchasSanDiego,haveadoptedthisrule.70Therefore,itisimportanttoknowyourlocalcourtrules.

IfaminorisinDJJcustody,psychotropicmedicationrequiresinformedconsentand“shallbeorderedandadministeredonlyafterapsychiatrist,inconsultationwiththetreatmentteam,hasevaluatedtheward,arrivedatadifferentialdiagnosis,andconcludedthatthewardwouldbenefitfromapsychotropicmedication.”15CCR§4746(a)(d).Generallyaparentorguardianmustprovideinformedconsentforpsychotropicmedication;however,ifDJJisunabletolocatetheparentorguardian,“voluntary”medicationmaybeadministeredif(1)twophysicianshavereviewedtheneedandagreethatitismedicallyappropriate,(2)theminoragreestotheadministrationofpsychotropicmedication,(3)andan“applicationforOrderforPsychotropicMedication‐Juvenile(JV220)isfiledwiththejuvenilecourt.15CCR§4746.5.TheproceduresdescribedinSection4747oftheCaliforniaAdministrativeCodeshouldbefollowedwhenaparentorguardianhasdeniedconsentorisunavailable.See15Cal.CodeRegs.§4747.• EmergencyProvisionofMedicationAbsentaCourtOrderEvenifcourtauthorizationgenerallyisnecessary,psychotropicmedicationsneverthelessmaybeadministeredinemergencieswithoutcourtauthorization.Inthiscontext,anemergencysituationoccurswhen:(A) Aphysicianfindsthatthechildrequirespsychotropicmedicationtotreata

psychiatricdisorderorillness;and(B) Thepurposeofthemedicationis:

i. Toprotectthelifeofthechildorothers,orii. Topreventseriousharmtothechildorothers,oriii. Totreatcurrentorimminentsubstantialsuffering;and

(C) Itisimpracticaltoobtainauthorizationfromthecourtbeforeadministeringthepsychotropicmedicationtothechild.

Cal.R.Ct.5.640(g).

orderdelegatingthisauthoritytoaparentuponmakingfindingsontherecordthattheparentposesnodangertotheminorandhasthecapacitytoauthorizepsychotropicmedications.Courtauthorizationfortheadministrationofpsychotropicmedicationshallbebasedonarequestfromaphysician,indicatingthereasonsfortherequest,adescriptionoftheminor'sdiagnosisandbehavior,theexpectedresultsofthemedication,andadescriptionofanysideeffectsofthemedication.OnorbeforeJuly1,2008,theJudicialCouncilshalladoptrulesofcourtanddevelopappropriateformsforimplementationofthissection.").69Cal.R.Ct.5.640(h)(“Alocalruleofcourtmaybeadoptedprovidingthatauthorizationfortheadministrationofsuchmedicationtoachilddeclaredawardofthecourtundersections601and602andremovedfromthecustodyoftheparentorguardianforplacementinafacilitythatisnotconsideredafoster‐careplacementmaybesimilarlyrestrictedtothejuvenilecourt.Ifthelocalcourtadoptssuchalocalrule,thentheproceduresunderthisruleapply;anyreferencetosocialworkeralsoappliestoprobationofficer.”).70Forexample,SanDiegoCounty’sJuvenileCourtadoptedsucharule.TheSanDiegoJuvenileCourtmustauthorizeanyrequesttoputawardonpsychotropicmedication.SanDiegoCt.R.6.9.12.

Ifmedicationisadministeredinanemergency,courtauthorizationstillmustbesoughtassoonaspossiblebutnolaterthantwocourtdaysaftertheemergencyadministrationofthepsychotropicmedication.”Id.

• MedicationforWardsinFacilitiesJuvenilefacilitiesmustmakeprovisionstoensurethatminorsalreadyonpsychotropicmedicationwhentheyenterafacilityarecontinuedontheirmedicationpendingre‐evaluation.15CCR§1439(a)(4).Exceptinemergencies,psychotropicmedicationcannotbeadministeredtominorsinfacilitiesabsentinformedconsentfromtheappropriatepersonorentity.Aspartoftheinformedconsentprocess,theminormustbeinformedoftheexpectedbenefits,potentialsideeffectsandalternativestopsychotropicmedications.15CCR§1439(b).71Minorscannotbeadministeredpsychotropicmedicationasameansofcoercion,discipline,convenienceorretaliation.15CCR§1439.• RighttoRefuseMedicationMinorswhohavebeeninvoluntarilydetainedorhospitalizedpursuanttosections5150,5250,5260or5270.15oftheWelfareandInstitutionsCodehavearighttorefuseadministrationofantipsychoticmedication.Cal.Welf.&Inst.Code§5332.72Shouldaninvoluntarypatientobjecttomedication,thehospitalmustrequestahearingtoauthorizeinvoluntaryadministration.73Onlyinverylimitedcircumstancesmaytheminorbeadministeredmedicationoverhisorherobjection.74Wardsincountyjuvenilefacilitieshavetherighttorefusemedication;however,inemergencies,medicationmaybeadministeredinvoluntarily.15CCR§1439(b)(2);(c).75

7115CCR§1439(b)(“Psychotropicmedicationsshallnotbeadministeredtoaminorabsentanemergencyunlessinformedconsenthasbeengivenbythelegallyauthorizedpersonorentity.(1)Minorsshallbeinformedoftheexpectedbenefits,potentialsideeffectsandalternativestopsychotropicmedications.(2)Absentanemergency,minorsmayrefusetreatment”).72WIC§5332(a)(“Antipsychoticmedication,asdefinedinsubdivision(l)ofSection5008,maybeadministeredtoanypersonsubjecttodetentionpursuanttoSection5150,5250,5260,or5270.15,ifthatpersondoesnotrefusethatmedicationfollowingdisclosureoftherighttorefusemedicationaswellasinformationrequiredtobegiventopersonspursuanttosubdivision(c)ofSection5152andsubdivision(b)ofSection5213.”).73WIC§5332(“(b)IfanypersonsubjecttodetentionpursuanttoSection5150,5250,5260,or5270.15,andforwhomantipsychoticmedicationhasbeenprescribed,orallyrefusesorgivesotherindicationofrefusaloftreatmentwiththatmedication,themedicationshallbeadministeredonlywhentreatmentstaffhaveconsideredanddeterminedthattreatmentalternativestoinvoluntarymedicationareunlikelytomeettheneedsofthepatient,anduponadeterminationofthatperson'sincapacitytorefusethetreatment,inahearingheldforthatpurpose.(c)Eachhospitalinconjunctionwiththehospitalmedicalstafforanyothertreatmentfacilityinconjunctionwithitsclinicalstaffshalldevelopinternalproceduresforfacilitatingthefilingofpetitionsforcapacityhearingsandotheractivitiesrequiredpursuanttothischapter.”).74Seee.g.WIC§5332(e)(“Inthecaseofanemergency,asdefinedinsubdivision(m)ofSection5008,apersondetainedpursuanttoSection5150,5250,5260,or5270.15maybetreatedwithantipsychoticmedicationoverhisorherobjectionpriortoacapacityhearing,butonlywithantipsychoticmedicationthatisrequiredtotreattheemergencycondition,whichshallbeprovidedinthemannerleastrestrictivetothepersonallibertyofthepatient.Itisnotnecessaryforharmtotakeplaceorbecomeunavoidablepriortointervention.”).7515CCR§1439(c)(“Minorsfoundbyaphysiciantobeadangertothemselvesorothersbyreasonofamentaldisordermaybeinvoluntarilygivenpsychotropicmedicationimmediatelynecessaryforthepreservationoflifeorthepreventionofseriousbodilyharm,andwhenthereisinsufficienttimetoobtainconsentfromteparent,guardian,or

WardsinDJJcustodyalsomayrefusepsychotropicmedication.15CCR§4734.However,inlimitedcircumstances,theytoomaybeadministeredpsychotropicmedicationonaninvoluntarybasis.15CCR§§4735(c);4747.76Administeringpsychotropicmedicationonaninvoluntarybasisrequiresdetaileddueprocess.Becausethissectiononlyprovidesasimpleoverviewoftheprocess,providersshouldspeaktotheirowncounselformoreinformationandadvice.77

7. PregnancyandotherReproductiveHealthCareAminor’sconsentisrequiredforallpregnancyrelatedcare,includingcontraception,prenatalcare,andabortionservices.Cal.FamilyCode§6925;78AmericanAcademyofPediatricsv.Lungren,16Cal.4th307,383(1997).Theconsentofnootherpersonisnecessary.Thisruleappliesirrespectiveoftheageoftheyouth;however,ifaveryyoung

courtbeforethethreatenedharmwouldoccur.Itisnotnecessaryforharmtotakeplaceorbecomeunavoidablepriortoinitiatingtreatment.”).7615CCR§4747(“(a)Involuntarypsychotropicmedicationmaybeadministeredinanemergency.Anemergencyexistswhen:(1)Thereisamarkedchangeintheward'sconditionthatindicatesthatactionisimmediatelynecessaryforthepreservationof life or thepreventionof bodily harm to self or others, and (2) It is impracticable or impossible toobtaininformedconsent.(b)Theadministrationofpsychotropicmedicationinanemergencyshallbeonlythatwhichis required to treat the emergency condition and shall be provided inwayswhich are the least restrictive to thepersonallibertyoftheward.(c)Theadministrationofpsychotropicmedicationinanemergencymaybecontinuedfor72hoursontheorderofthepsychiatristorphysician.(d)Thechiefmedicalofficerateachfacilityshallensurethatalog ismaintainedinwhicheachoccasionof involuntarypsychotropicmedicationisrecordedforeachward.(1)Thelogshallidentifythewardbynameandnumber,andshallincludethenameoftheorderingphysician,thereasonformedicationandthetimeanddateofmedication.(2)The logshallbereviewedbythechiefmedicalofficerat leastmonthlyandshallbemadeavailableforreviewbythechiefofthehealthcareservicesdivisionuponrequest.(e)Theadministrationof involuntarypsychotropicmedication inexcessof 72hours forwards18 yearsof ageorolderoremancipatedminorsshallbeprohibitedunlesssuchwardsareprovidedwiththeprotectionsrequired inKeyheav.Rushen,SolanoCountySuperiorCourtNo.67432,OrderGrantingPlaintiffsMotionforClarificationandModificationof InjunctionandPermanent Injunction,filedOctober31,1986. (1)Theadministrationof involuntarypsychotropicmedicationinexcessoftendaysshallbeprohibitedunlesssuchwardsareprovidedwiththeprotectionsrequiredinKeyheav.Rushen,supra.(2)Theadministrationofinvoluntarypsychotropicmedicationinexcessof24daysshallbeprohibitedunlesssuchwardsareprovidedwiththeprotectionsrequiredinKeyheav.Rushen,supra.(A)ThejudicialhearingfortheauthorizationfortheinvoluntaryadministrationofpsychotropicmedicationprovidedforinpartIIIofKeyhea v. Rushen, supra, shall be conducted by an administrative law judge. (B) The judicial hearingmay, at thedirectionofthedirector,beconductedatthefacilitywherethewardislocated.(f)Theadministrationofinvoluntarypsychotropicmedication inexcessofthe72hoursforwardsundertheageof18whoarenotemancipatedminorsshallbeinaccordancewiththefollowingandshalloccuronlywhenaparentorguardiandeniesconsentasdefinedinArticle1,Section4733orwhenaparentorguardianisnotavailable:(1)Ifconsentisdeniedbyaparentorguardianand thewardmeets thecriteria identified inKeyheav.Rushen, supra, theprocedures in subsection (c)(1) through(c)(4) shall be initiated. (2) If consent is denied by a parent or guardian and theward does notmeet the criteriaidentified in Keyhea v. Rushen supra but has a diagnosed mental health condition that would benefit frompsychotropicmedication,medicationshallnotbeadministered.PsychotherapyshallbeinitiatedandtheprogressandoutcomerecordedintheUnifiedHealthRecord.(3)IftheparentorguardianisnotavailableandthewardmeetsthecriteriaidentifiedinKeyheav.Rushen,supra,theproceduresinsubsection(c)(1)through(c)(4)shallbeinitiated.(4)IftheparentorguardianisnotavailableandthewarddoesnotmeetthecriteriaidentifiedinKeyheav.Rushen,supra,consultation from a community psychiatrist shall be obtained. Administration of psychotropicmedication shall bebasedontherecommendationofthecommunitypsychiatrist.”).77Formoreinformation,seetheCaliforniaAssociationofMentalHealthPatients’RightsAdvocates,Patients’RightsManualavailableathttp://camhpra.org/home/index.php?option=com_content&task=category&sectionid=3&id=15&Itemid=16.78Cal.Fam.Code§6925(“(a)Aminormayconsenttomedicalcarerelatedtothepreventionortreatmentofpregnancy.”);Amer.AcademyofPediatricsv.Lungren,16Cal.4th307(1997).

minorissexuallyactive,practitionersshouldbesensitivetothepossibilityofsexualabuse.79

Juvenilefacilitieshousingwardsarerequiredtodeveloppoliciesandprocedurestoassurereproductivehealthservicesareavailabletobothmaleandfemalewards.80Takingitonestepfurther,somecountieshaveimplementedspecificpoliciestohelpensurethereproductivehealthneedsofalldetainedandcommittedareaddressed.Pleaseseeyourlocalcourtrulesandagencypoliciesforguidance.

8. PregnancyandotherReproductiveHealthCareforYouthinJuvenileFacilities

Inordertoensurefemaleshaveaccesstoreproductivehealthserviceswhileconfineinjuvenilefacilities81,Californiahaspassedseverallawsandregulationstoclarifytheirrightstofamilyplanning,abortion,prenatal,andbirthingcare.

• MinorConsentMinorsinjuvenilefacilitieshavetherighttoconsenttotheirownpregnancy‐relatedhealthcare.Whenaminor’sconsentisnecessaryorsufficientforservicesoutsidethefacility,theminorhasthesamerighttoconsenttothatcarewhendetainedin,orcommittedto,ajuvenilefacility.15CCR§1434.82

• BirthControl/FamilyPlanningStateandlocaljuvenilefacilities83mustallowfemales,upontheirrequest,tocontinuetousebirthcontrolmeasuresasprescribedbyaphysicianandmaterialsnecessaryforpersonalhygienewithregardtothemenstrualcycleandreproductivesystem.Welf.&Inst.Code§221(a).84Familyplanningservicesmustbeofferedtoeverydetainedandcommittedfemaleatleast60dayspriortoascheduledreleasedate.Welf.&Inst.Code§221(c).85

79Formoreinformationonchildabuseandabusereportingrequirements,seeMinorConsent,ConfidentialityandChildAbuseReportinginCalifornia,availableatwww.TeenHealthRights.org.

8015CCR§1416(“Foralljuvenilefacilities,thehealthadministrator,incooperationwiththefacilityadministrator,shalldevelopwrittenpoliciesandprocedurestoassurethatreproductivehealthservicesareavailabletobothmaleandfemaleminors.”).81Thissectionreferstorightsofminorsincarceratedinstateandlocaljuvenilefacilities;howeversimilarprovisionsgrantfemalesconfinedinaDJJfacilitysimilarrights.SeeCal.Welf.&Inst.Code§§1753.7,1773,1774.8215CCR§1434(a)(“Allexaminations,treatments,andproceduresrequiringverbalorwritteninformedconsentinthecommunityalsorequirethatconsentforconfinedminors.”(c)“Policyandproceduresshallbeconsistentwithapplicablestatutesinthoseinstanceswheretheminor'sconsentfortestingortreatmentissufficientorspecificallyrequired.”).83WIC§221(d)(“Forthepurposesofthissection,"localjuvenilefacility"meansanycity,county,orregionalfacilityusedfortheconfinementofjuvenilesformorethan24hours.”).84WIC§221(“(a)Anyfemaleconfinedinastateorlocaljuvenilefacilityshalluponherrequestbeallowedtocontinuetousematerialsnecessaryfor(1)personalhygienewithregardtohermenstrualcycleandreproductivesystemand(2)birthcontrolmeasuresasprescribedbyherphysician.”).85WIC§221(c)(“Familyplanningservicesshallbeofferedtoeachandeverywomaninmateatleast60dayspriortoascheduledreleasedate.Uponrequestanywomaninmateshallbefurnishedbytheconfiningstateorlocalagencywiththeservicesofalicensedphysician,orsheshallbefurnishedbytheconfiningstateorlocalagencyorbyany

Uponrequestanywomaninmateshallbefurnishedbytheconfiningstateorlocalagencywiththeservicesofalicensedphysician,orsheshallbefurnishedbytheconfiningstateorlocalagencyorbyanyotheragencywhichcontractswiththeconfiningstateorlocalagency,withservicesnecessarytomeetherfamilyplanningneedsatthetimeofherrelease.Cal.Welf.&Inst.Code§221(c).Shealsomustbefurnished,uponrequest,withinformationandeducationregardingprescriptionbirthcontrolmeasures.Cal.Welf.&Inst.Code§221(b).86• PregnancyTestingandPregnancyCareFemalesincustodyincountyjuvenilefacilities87havetherighttothe“servicesofanyphysicianandsurgeonofherchoiceinordertodeterminewhethersheispregnant.Ifsheisfoundtobepregnant,sheisentitledtoadeterminationoftheextentofthemedicalservicesneededbyherandtothereceiptofthoseservicesfromthephysicianandsurgeonofherchoice.Anyexpensesoccasionedbytheservicesofaphysicianandsurgeonwhoseservicesarenotprovidedbythefacilityshallbebornebythefemale.”Cal.Welf.&Inst.Code§222(a).Thisrightmustbepostedinatleastoneconspicuousplacetowhichallfemalewardshaveaccess.Id.at(d).88• AbortionJuvenilefacilities89cannotconditionorrestrictafemale’saccesstoabortionservices.Ifafemaleinajuvenilefacilityispregnantandchoosestoabort,thefacilitymustpermithertoobtaintheabortion.Welf.&Inst.Code§220.90Thejuvenilefacilitymustpostthisrightinaconspicuousplacetowhichallfemaleshaveaccess.Id.• ChildbirthFemalesinjuvenilefacilitieshavethefollowingrightsduringchildbirth.“Awardshallnotbeshackledbythewrists,ankles,orbothduringlabor,includingduringtransporttoahospital,duringdelivery,andwhileinrecoveryaftergiving

otheragencywhichcontractswiththeconfiningstateorlocalagency,withservicesnecessarytomeetherfamilyplanningneedsatthetimeofherrelease.”).86WIC§221(b)(“Anyfemaleconfinedinastateorlocaljuvenilefacilityshalluponherrequestbefurnishedbytheconfiningstateorlocalagencywithinformationandeducationregardingprescriptionbirthcontrolmeasures.”).87WIC§221(c)(“Forpurposesofthissection,"localjuvenilefacility"meansanycity,county,orregionalfacilityusedfortheconfinementofjuvenilesformorethan24hours.”).88WIC§222(d).89WIC§220(“Forthepurposesofthissection,"localjuvenilefacility"meansanycity,county,orregionalfacilityusedfortheconfinementoffemalejuvenilesformorethan24hours.”).90WIC§220(“Noconditionorrestrictionupontheobtainingofanabortionbyafemaledetainedinanylocaljuvenilefacility,pursuanttotheTherapeuticAbortionAct(Article2(commencingwithSection123400)ofChapter2ofPart2ofDivision106oftheHealthandSafetyCode),otherthanthosecontainedinthatact,shallbeimposed.Femalesfoundtobepregnantanddesiringabortions,shallbepermittedtodeterminetheireligibilityforanabortionpursuanttolaw,andifdeterminedtobeeligible,shallbepermittedtoobtainanabortion.…Therightsprovidedforfemalesbythissectionshallbepostedinatleastoneconspicuousplacetowhichallfemaleshaveaccess.”).

birth,subjecttothesecurityneedsdescribedinthissection.Pregnantwardstemporarilytakentoahospitaloutsidethefacilityforthepurposesofchildbirthshallbetransportedintheleastrestrictivewaypossible,consistentwiththelegitimatesecurityneedsofeachward.Uponarrivalatthehospital,oncethewardhasbeendeclaredbytheattendingphysiciantobeinactivelabor,thewardshallnotbeshackledbythewrists,ankles,orboth,unlessdeemednecessaryforthesafetyandsecurityoftheward,thestaff,andthepublic.”Cal.Welf.&Inst.Code§222(b).Theserightsmustbepostedinatleastoneconspicuousplacetowhichallfemalewardshaveaccess.91

9. SexuallyTransmittedDiseases

Minors12yearsoldandolder,includingminorsinvolvedwiththejuvenilejusticesystem,whomayhavecomeintocontactwithaninfectious,contagious,orcommunicablediseasemayconsenttomedicalcarerelatedtothediagnosisortreatmentofthedisease,ifthediseaseorconditionisonethatisrequiredbylaworregulationadoptedpursuanttolawtobereportedtothelocalhealthofficer,orisarelatedsexuallytransmitteddisease,asmaybedeterminedbytheStateDirectorofHealthServices.Cal.FamilyCode§6926(a).92

Forminorslessthan12yearsofage,theconsentrulesdescribedinsections(A)and(B),above,apply.Somecountieshaveimplementedspecificpoliciestoinsureminorshaveaccesstotheseservicesasneeded.93Pleaseseeyourlocalrulesforguidance.

Minors12andolderwhoareindetentionhavetherighttoconsenttotheseservices;however,undersomecircumstances,wardscommittedtoadetentionfacilitymaybeobligatedtosubmittotestingforcertaininfectiousorcommunicablediseases.See“HIVTesting”and“Infectious,communicablediseases”above.

10. SexualAssaultTreatment

Aminorofanyage,includingminorsinvolvedwiththejuvenilejusticesystem,mayconsenttomedicalcarerelatedtodiagnosisandtreatmentofsexualassault,andthecollectionofmedicalevidencewithregardtotheallegedsexualassault.Cal.Fam.Code§6928(b).94SexualassaultofaminorisconsideredchildabuseandmustbereportedtoCPSorlawenforcement,eveniftheminoralreadyisundercourtjurisdiction.95

91WIC§222(d).92Cal.Fam.Code§6926(a)(“(a)Aminorwhois12yearsofageorolderandwhomayhavecomeintocontactwithaninfectious,contagious,orcommunicablediseasemayconsenttomedicalcarerelatedtothediagnosisortreatmentofthedisease,ifthediseaseorconditionisonethatisrequiredbylaworregulationadoptedpursuanttolawtobereportedtothelocalhealthofficer,orisarelatedsexuallytransmitteddisease,asmaybedeterminedbytheStateDirectorofHealthServices.”).93Forexample,theCountyofNevadaencouragesscreeningsexuallyactiveminorsforvenerealdiseasebutonly“uponconsentoftheminor.”SeeNevadaCountyJuvenileCourtRule6.07.1.

94Cal.Fam.Code§6928(b)(“Aminorwhoisallegedtohavebeensexuallyassaultedmayconsenttomedicalcarerelatedtothediagnosisandtreatmentofthecondition,andthecollectionofmedicalevidencewithregardtotheallegedsexualassault.”).

95SeeCalifornia’sChildAbuseandNeglectReportingAct:ReportingRulesforHealthCareProviders,availableatwww.TeenHealthRights.org.

Juvenilefacilitiesmustestablishpoliciesandprocedurestotreatvictimsofsexualassaultsandensureassaultsarereported.Theevidentiaryexamandinitialtreatmentofsexualassaultmustbeconductedatahealthfacilitythatisseparatefromthecustodialfacilityandisproperlyequippedandstaffedwithpersonneltrainedandexperiencedinsuchprocedures.15C.C.R.§1453.

11. SubstanceAbuse:TestingandTreatment

Minorsage12yearsoldorolder,includingminorsinvolvedwiththejuvenilejusticesystem,mayconsenttomedicalcareandcounselingrelatingtothediagnosisandtreatmentofdrugoralcoholrelatedproblems.Cal.FamilyCode§6929(b).96Thissectionoflawdoesnotauthorizetheminortoconsenttoreplacementnarcoticabusetreatment(methadone).Cal.Fam.Code§6929(e).97

Inthealternative,whenaminordoesnotconsenttotreatment,aparent,guardianorotherpersonwithconsentrightsalsomayauthorizecareontheminor’sbehalf.Cal.Fam.Code§6929(f).Inthesesituations,theconsentrulesdescribedinsections(A)and(B),above,apply.Aswell,thecourtmayorderawardcommittedtoafacilityfor72‐hourtreatmentandevaluationifthewardappearstobeadangertohimselforherselforothersasaresultoftheuseofcontrolledsubstances.Thelawallowsforcontinuedinvoluntarytreatmentinsomecircumstances.SeeCal.Welf.&Inst.Code§708.

Whenaminoristakenintotemporarycustodybyapeaceofficerundersection625oftheWelfareandInstitutionsCode,thepeaceofficermayrequestthattheminorsubmittovoluntarychemicaltestingofhisorherurineforthepurposeofdeterminingthepresenceofalcoholorillegaldrugs,butthepeaceofficermustinformtheminorthatthetestisvoluntaryandtheresultmaybeconsideredbythecourt.Theofficerisrequiredtorecitespecificadmonitionstothiseffect.Cal.Welf.&Inst.Code§§625.1;625.2.(Note:thisisdifferentthanachemicaltestadministeredpursuanttoVehicleCode§23157.)

96Cal.Fam.Code§6929(“(b)Aminorwhois12yearsofageoroldermayconsenttomedicalcareandcounselingrelatingtothediagnosisandtreatmentofadrug‐oralcohol‐relatedproblem….(e)Thissectiondoesnotauthorizeaminortoreceivereplacementnarcoticabusetreatment,inaprogramlicensedpursuanttoArticle3(commencingwithSection11875)ofChapter1ofPart3ofDivision10.5oftheHealthandSafetyCode,withouttheconsentoftheminor'sparentorguardian.”).97Cal.Fam.Code§6929(e)(”Thissectiondoesnotauthorizeaminortoreceivereplacementnarcoticabusetreatment,inaprogramlicensedpursuanttoArticle3(commencingwithSection11875)ofChapter1ofPart3ofDivision10.5oftheHealthandSafetyCode,withouttheconsentoftheminor'sparentorguardian.”).

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