CALIFORNIA CODE OF REGULATIONS - State of California

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Page 487 TITLE 9. DIVISION 1 — DEPARTMENT OF MENTAL HEALTH § 836.2 evaluation and treatment facilities pursuant to Section 5150 of the Welfare and Institutions Code must count Saturdays, Sundays, and holidays as part of the 72–hour period unless exempted by the Department. NOTE: Authority cited: Section 5151, Welfare and Institutions Code. Reference: Section 5151, Welfare and Institutions Code. § 825.1. Exemption Requests. Facilities wishing to be exempted from this requirement must apply through the Local Mental Health Director who shall submit a written request to the Department requesting such exemption. NOTE: Authority cite: Section 5151, Welfare and Institutions Code. Reference: Section 5151, Welfare and Institutions Code. § 825.2. Exemption Request Requirements. The request shall include the following information: (a) The identity of the facility for which the exemption is requested; (b) The reason(s) that evaluation and treatment services cannot be made available on Saturdays, Sundays, and holidays. If the reason relates to staffing, there shall be included a statement explaining normal staffing standards pursuant to Article 10 of Subchapter 3 on days when evaluation and treatment services are provided and why such staffing is not available on Saturdays, Sundays, and holidays. (c) A description of the efforts the facility has made and will make to provide evaluation and treatment services on Saturdays, Sundays, and holidays. NOTE: Authority cited: Section 5151, Welfare and Institutions Code. Reference: Section 5151, Welfare and Institutions Code. § 825.3. Certification of Exemptions. The Department will either certify that the facility cannot reasonably provide evaluation and treatment services on Saturdays, Sundays, and holidays or deny such certification. If granted, the certification shall be effective for two years unless revoked in accordance with Section 825.4. NOTE: Authority cited: Section 5151, Welfare and Institutions Code. Reference: Section 5151, Welfare and Institutions Code. § 825.4. Reapplication for or Revocation of Certification. If certification is denied a facility, the Local Mental Health Director may reapply for certification at any time. In addition, prior certifications exempting facilities may be revoked by the Department upon a finding that the facility can reasonably be expected to provide such services and after written notice and opportunity for the facility to respond has been given. NOTE: Authority cited: Section 5151, Welfare and Institutions Code. Reference: Section 5151, Welfare and Institutions Code. § 829. Mental Health Treatment Facility. NOTE: Authority cited: Sections 1500 and 1851, Probate Code. References: Sections 1500 and 1851, Probate Code and division 5, part 1, chapter 2 and chapter 3, Welfare and Institutions Code. Article 4. § 830. Conservatorship. Article 5. Conservatorship Patients’ Rights: Convulsive Treatment and Psychosurgery § 835. General Provision. Any person, without regard to where that person is treated, shall have the right to refuse convulsive treatment, insulin coma treatment, prefrontal sonic treatment, and psychosurgery, except as otherwise provided by statute or regulation. In addition, any administration of these treatments or performance of psychosurgery, wherever administered or performed, shall be performed only by a physician licensed to practice in the State of California, and shall be subject to the regulations contained in this Article. NOTE: Authority cited: Sections 5325(g), 5326.95 and 5400, Welfare and Institutions Code. Reference: Sections 5325(f), 5325.1(i), 5326.6, 5326.7, 5326.75 and 5326.85, Welfare and Institutions Code. § 836. Types of Treatment: Definitions. (a) ‘‘Convulsive treatment’’ is the planned induction of a seizure through electrical or chemical means for therapeutic purposes. When more than one seizure is induced in a single treatment session, each seizure shall be considered a separate treatment for records–keeping and reporting purposes. (b) ‘‘Insulin Coma Treatment’’ consists of the production of a coma for therapeutic purposes, with or without convulsions, through the intramuscular administration of insulin. (c) ‘‘Psychosurgery’’ is defined as any of those operations currently referred to as lobotomy, psychiatric surgery, and behavioral surgery and all other forms of brain surgery if the surgery is performed for the purpose of any of the following: (1) Modification, alteration, or control of thoughts, feelings, actions, or behavior rather than the treatment of a known and diagnosed physical disease of the brain; (2) Modification or alteration of normal brain function, brain tissue or brain cells in order to modify, alter, or control thoughts, feelings, actions, or behavior; or (3) Treatment of abnormal brain function, brain tissue or brain cells in order to modify, alter, or control thoughts, feelings, actions, or behavior when the abnormality is not an established cause for those thoughts, feelings, actions, or behavior. Psychosurgery shall not include surgery for relief of pain caused by physical disease elsewhere in the body. (d) “Prefrontal sonic treatment” is the direct stimulation and/or destruction of brain cells or brain tissue by ultrasound for therapeutic purposes, as discussed in Section 837. NOTE: Authority cited: Sections 5325(g), 5326.95 and 5400, Welfare and Institutions Code. Reference: Sections 5325, 5326.6, 5326.7, 5326.75, 5326.8 and 5326.85, Welfare and Institutions Code. § 836.1. Voluntary and Involuntary Patients: Definitions. (a) “Involuntary patients,” for purposes of this Article, include: (1) Persons involuntarily detained for 72–hour evaluation and treatment under Section 5150 of the Welfare and Institutions Code; (2) Persons certified for intensive treatment under Section 5250 of the Welfare and Institutions Code; (3) Persons certified for additional intensive treatment as suicidal under Section 5260 of the Welfare and Institutions Code; (4) Persons postcertified as a demonstrated danger of substantial physical harm to others under Section 5300 of the Welfare and Institutions Code; (5) Persons under temporary or permanent conservatorship or guardianship; (6) Persons who have been judicially committed, as defined under Section 5008.1 of the Welfare and Institutions Code. In the event that this Article conflicts with regulations dealing with the developmentally disabled promulgated under Chapter 1 (commencing with Section 4500) of the Welfare and Institutions Code, the latter statute and regulations shall control. (b) “Voluntary patients,” for the purposes of this Article, include all other patients not included in subdivision (a) above. NOTE: Authority cited: Sections 5326.95 and 5400, Welfare and Institutions Code. Reference: Sections 5326.7, 5326.15 and 5326.75, Welfare and Institutions Code. § 836.2. Facility: Definition. “Facility” includes any health facility, including but not limited to, any health facility as defined in Section 1250 of the Health and Safety Code, in which convulsive treatment, insulin coma treatment, prefrontal sonic treatment or psychosurgery is administered or performed.
§ 837 CALIFORNIA CODE OF REGULATIONS Page 488 NOTE: Authority cited: Sections 5326.95 and 5400, Welfare and Institutions Code. Reference: Sections 5325, 5326.6, 5326.7, 5326.15 and 5326.75, Welfare and Institutions Code. § 837. Procedures for Insulin Coma and Prefrontal Sonic Treatment. (a) Unless otherwise indicated, all the requirements set forth in statute or regulation for the administration of convulsive treatment shall be followed when insulin coma treatment is administered, or when prefrontal sonic treatment is administered which involves only direct stimulation of brain cells or brain tissue. (b) Unless otherwise indicated, all the requirements of statute or regulation described for psychosurgery shall be followed when prefrontal sonic treatment is administered and there exists any possibility there will be destruction of brain cells or brain tissue. NOTE: Authority cited: Sections 5325(g), 5326.95 and 5400, Welfare and Institutions Code. Reference: Sections 5326.6, 5326.7 and 5326.75, Welfare and Institutions Code. § 838. Quarterly Reports on Convulsive, Insulin Coma, and Prefrontal Sonic Treatment—Application and Requirement. (a) The reporting requirements of Welfare and Institutions Code Section 5326.15 shall be applicable to all facilities which administer or perform convulsive treatment, insulin coma treatment, or prefrontal sonic treatment involving only direct stimulation of cells or tissue, and to all physicians who provide these treatments outside health facilities. (b) Quarterly, any such facility which has performed these treatments during the prior quarter, or which considers such treatment methods a part of the facility’s program, shall report to the local mental health director. These reports shall be made regardless of whether or not any of these treatment methods were used during the quarter. Likewise, any physician who considers any of these methods a service that he or she provides, and whose use of the above–mentioned treatment methods is not included in any facility’s report, must submit a quarterly report to the local mental health director even if such treatments were not administered during that particular quarter. (c) Quarterly reports shall be made on a form which shall be issued by the Director of the State Department of Mental Health which shall include all necessary instructions and definitions. NOTE: Authority cited: Sections 5325(g), 5326.95 and 5400, Welfare and Institutions Code. Reference: Sections 5326.1 and 5326.15, Welfare and Institutions Code. § 838.1. Quarterly Reports on Psychosurgery. Each facility which performs psychosurgery, or prefrontal sonic treatment involving destruction of cells or tissue, or each physician who performs these treatments outside a facility, shall submit to the local mental health director a quarterly report of all such procedures actually performed during the preceding quarter. The report shall contain, in addition to the data listed in Welfare and Institutions Code Section 5326.15, the following information: (a) Psychiatric diagnosis; (b) Type of psychosurgery performed; (c) Date surgery performed; (d) Complications that arose during or after completing psychosurgery. NOTE: Authority cited: Sections 5326.95 and 5400, Welfare and Institutions Code. Reference: Section 5326.15, Welfare and Institutions Code. § 838.2. Failure to Submit Quarterly Reports. A facility, clinic, or physician who fails to submit the reports as provided in Section 838 or 838.1, by the 15th of the month following completion of the quarter, shall be notified by the local mental health director of the legal obligation to submit these reports. Failure to comply within 15 days after such notification shall be reported to the Director of the State Department of Mental Health who may take any or all of the actions specified in Section 5326.9 of the Welfare and Institutions Code. NOTE: Authority cited: Sections 5325(g), 5326.95 and 5400, Welfare and Institutions Code. Reference: Section 5326.15, Welfare and Institutions Code. § 838.3. Quarterly Reports to State. The local mental health director shall transmit copies of all quarterly reports received to the Director of the State Department of Mental Health, or to the office designated by the Director, by the last day of the month following the end of the quarter. NOTE: Authority cited: Sections 5325(g), 5326.95 and 5400, Welfare and Institutions Code. Reference: Sections 5326.1 and 5326.15, Welfare and Institutions Code. § 839. Informed Consent for Electroconvulsive Treatment. (a) For purposes of obtaining written informed consent to electroconvulsive treatment, the treating physician shall use the consent form developed by the department. The form entitled “Informed Consent for Electroconvulsive Treatment (ECT) MH 300 (11/90)” is the standard written consent form prescribed in section 5326.3 of the Welfare and Institutions Code. (b) The oral explanation required by section 5326.4 of the Welfare and Institutions Code regarding the information contained on the consent form shall be in a language or modality understood by the person giving consent. NOTE: Authority cited: Section 5326.95, Welfare and Institutions Code. Reference: Sections 5325, 5326.2, 5326.3, 5326.4, 5326.5, 5326.6, 5326.7, 5326.75 and 5326.8, Welfare and Institutions. § 840. Capacity to Consent or Refuse Consent to Recommended Treatment or Surgery. (a) A person shall be deemed to have the capacity to consent or to refuse to consent if it is determined that such person has actually understood and can knowingly and intelligently act upon the information specified in Welfare and Institutions Code Section 5326.2. Understanding of the potential benefits and risks of the proposed treatment or surgery is the primary factor in determining such capacity to consent or to refuse consent. (b) A person shall not be deemed to lack capacity to consent or refuse consent solely by virtue of any psychiatric or medical diagnosis. (c) When Section 5326.7(e) of the Welfare and Institutions Code requires that a person’s attorney make a determination as to the person’s capacity or incapacity to give written informed consent, the attorney shall make an independent judgment of capacity. NOTE: Authority cited: Sections 5325(g), 5326.95 and 5400, Welfare and Institutions Code. Reference: Sections 5326.5, 5326.7 and 5326.75, Welfare and Institutions Code. § 841. Refusal to Consent to Recommended Treatment or Surgery. If a patient is deemed by the physician to have the capacity to give informed consent, but refuses to do so, the physician shall indicate in the clinical record that the treatment was refused despite the physician’s advice, and that he or she has explained to the patient the patient’s responsibility for any untoward consequence of the refusal. However, such explanation shall in no case be made in a manner so as to constitute duress or coercion. Transfer of the patient to another facility, loss of hospital privileges or placement in a more restrictive setting may subsequently be justified for medical or psychiatric reasons, but shall not be a direct consequence of the patient’s refusal to consent to the proposed treatment. NOTE: Authority cited: Sections 5325(g), 5326.95 and 5400, Welfare and Institutions Code. Reference: Sections 5326.5 and 5326.85, Welfare and Institutions Code. § 845. Minors. (a) Under no circumstances shall psychosurgery or prefrontal sonic treatment be performed on a person under 18 years of age.
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CALIFORNIA CODE OF REGULATIONS - State of California

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