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4/19/2021

IMDs and medication compliance

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Just a quick update.....
      In regards to those wondering about medication compliance and placements in IMDs... IMD's usually prefer to see their patients medicated and compliant. Alpine intake paperwork specifically states that they do not tolerate noncompliance. When managing clients on LPS conservatorship, the letters and orders stipulate that the LPS conservator has the right to order involuntary psychiatric medication. However, in reality most IMDs in San Diego and LA do not engage in daily forced medication administration; rather, they use verbal encouragement to make the patient more compliant. Alpine Special Treatment Center has been known to be the IMD to use the least amount of restraint and involuntary medication administration. 

What more realistically plays out is that the hospital will hold the patient until they are stable and ready for transfer to an IMD. They want to see the patient who has some degree of insight and willingness to adhere to medication before discharge. Once discharged to the IMD the patient will do their activities and therapies in the IMD. If noncompliance becomes an issue, then the IMD will try verbal techniques to encourage med compliance. If verbal deescalation does not work and too many emergency IM injections are required then the IMD can transfer the conservatee back to the facility for stabilization and med compliance. The hospital may also transfer the conservatee back to a different facility if the previous facility is unable to take back the patient. 

The IMDs have changed in that they are less hands on and work to preserve the patient's rights. Because of this IMDs try and use less restrictive methods of encouraging med compliance. They can also work on having the patient transition to a long acting IM shot to encourage med compliance without daily struggle of oral medication. Invega sustenna/trinza and Abilify Maintena are two commonly used long acting IM injectables.


Now within the world of hypothetical legal scenarios...

Would IMD return the conservatee to acute inpatient hospital or would there be a hearing to modify placement to move conservatee to a higher level of care such as Metropolitan Adult Acute LPS Unit/ Atascadero? (San Diego county supposedly contracts only a limited number of beds in the state hospital system and most of those are for murphy conservatorships)
 
Given that the current legal authority mandates that a “long-term Lanterman–Petris–Short Act conservatee possesses the right to refuse antipsychotic medication absent a determination of incompetence” In re Welf. & Inst.Code § 5000 et seq/ in re Keyhea v. Rushen (1986) 178 Cal.App.3d 526, 542 there would need to be a showing that the conservatee does lack capacity at an evidentiary hearing.
 
Assuming that this required prior determination of incompetence would be satisfied upon the imposition of disabilities under §§ 5357-5358 where the conservator has the power to require the conservatee to receive mental health treatment related to remedying the grave disability would these disabilities suffice for Metropolitan hospital to forcibly give routine daily antipsychotic medication/monthly IM depot meds. 
 
Should state hospital not consider the § 5358 powers in the letters of LPS Conservatorship valid then would state hospital petition to ask a court to make a Qawi order, which authorizes state hospital to involuntarily administer daily nonemergency antipsychotic medication. In re Qawi, 32 Cal. 4th 1, 81 P.3d 224 (2004)? And although Qawi orders are for mental disordered offenders and the like, could there be a case where one is written for an LPS conservatee to enforce daily anti psychotics? 

I doubt it but still.... pure speculation


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Los Angeles Office of the Public Guardian 
510 S Vermont Ave, 14th Floor 
Los Angeles, California 90020 
Phone: LPS (213) 974-0527
(213) 974- 0407
Los Angeles Mental Health Court 
5925 Hollywood Blvd 
Los Angeles, California 90028 
Fax: (442) 247-3972


San Diego Central Courthouse
1100 Union St, Dept 1902
​LPS Hearings Tuesday/Thursday 9am
San Diego, California 92101 
Phone: (619) 844-2700



San Diego
Office of the Public Conservator

5560 Overland Ave Ste 130
San Diego, California 92123
Phone: (858) 694-3500 ext 2
© 2017 LPS Conserved   ALL RIGHTS RESERVED.
  • LPS CONSERVATORSHIPS FOR THE GRAVELY DISABLED
    • LPS Conservatorship Court Overview >
      • Public Conservator >
        • Los Angeles Public Guardian
        • CONSERVATORSHIP INVESTIGATION REPORT
        • CAREER >
          • Continuing Education
          • Public Conservator County Numbers '16
          • San Diego Public Conservator '19
        • LPS Conservatorship for Dependent Parents and Minors
      • WHY ARE LPS CONSERVATORSHIP AND PROBATE CONSERVATORSHIPS DIFFERENT
      • Court of Appeals >
        • In re Ben C- Wende Brief no issue writ
      • Trial Court Transcript
      • Conservatorship Legal Documents
      • INITIAL INVOLUNTARY PROCEEDINGS >
        • Grave Disability >
          • Present Grave Disability
        • Venue
        • Conservator's Bond
        • When the Conservatee Goes AWOL
        • Involuntary Commitment
        • Conservatorship Factors
        • Riese Hearing >
          • Riese Hearing
        • Supplemental Security Income/ SSI >
          • Applying for SSI
          • Documents for SSI
          • Process and Appeal
          • Award Letter
          • Rep Payee
          • SSI Amounts 2018/2019
  • LPS Conservatorship Case Law
    • THE ABSOLUTE STATE OF THE COURT OF APPEALS
    • Conservatorship of Isaac O- court report omission and jurisdiction
    • Disparate Treatment- Conservatorship of E.B
    • Conservatorship of KW- hearsay and jury instructions
    • Peremptory Challenges and Conservatorship of Gordon
    • Conservatorship of Sorenson privacy rights and LPS matters
    • Imposition of special disabilities- Conservatorship of Walker
    • Continuing Jurisdiction/Jury Instruction and Conservatorship of McKeown
    • Hearsay and conservatorship of Manton
    • Conservatorship of the Person of S.A.
    • Writ of Habeas Corpus burden of proof
    • Conservatorship of Roulet- burden of proof
    • Special disabilities and due process- Conservatorship of K.G and Donna H.
    • Conservatorship of Davis and Third party assistance
    • Marsden hearings/ due process Conservatorship of David
    • Conservatorship of Torres and admissibility
    • Jury Instruction and Conservatorship of Law
    • Conservatorship of George H- jury instruction
    • Public Conservator's Exclusive Power to Initiate LPS Conservatorship Kaplan v. Superior Court
    • Constitutionality of LPS conservatorship- Conservatorship of Delay
    • Investigation report- Conservatorship of Ivey
    • Conservatorship of Jesse G
    • Grave Disability Standard and Jury trial notice Conservatorship of Benvenuto
    • Conservatorship of Kennebrew vs Conservatorship of Karriker
    • Jury Trial Delays - Conservatorship of Joanne R.
    • Conservatorship of Hofferber- criminal incompetence and LPS
    • "Discretionary abuse" Conservatorship of G.H.
    • In re Elizabeth R- LPS Conserved Parent with a concurrent dependency case
    • Conservatorship of C.O. - Waiver of Jury Trial
    • Conservatorship of Smith and strange behaviour
    • Jury Trials- ​Conservatorship of Jose B
    • Conservatorship of Baber and Double jeopardy and third party evidence >
      • WIP- Conservatorship of Tedesco
      • Conservatorship of Symington (1989)
      • Effective Counsel
      • Faretta and Marsden
      • Exceptions: Third Party Evidence
      • Exclusionary Rule WIP
      • Fifth Amendment Rights
  • LIFETIME PROHIBITOR WELF & INST CODE § 8103 SUBD. (F)(1)(B) 18 U.S.C. § 922 (G) (4)
    • CA MHRS >
      • Armed and Prohibited Person System
    • National Instant Criminal Background Check System (NICS)
    • Registration
  • For LPS Conservatees
    • RIGHT TO APPEAR IN COURT
    • JUDICIAL REVIEW >
      • WRIT OF HABEAS CORPUS
    • NOTICE
    • MEDICATION
    • PLAN OF CARE IF DISCHARGED
    • RIGHT TO COUNSEL
  • BUILDING A STRONG CASE FOR CONSERVATORSHIP
    • POWERS OF CONSERVATOR >
      • Placement Powers
      • Medication powers
    • WHY ONLY THE PUBLIC CONSERVATOR IS ALLOWED TO FILE FOR LPS CONSERVATORSHIP
    • SERVING AS CONSERVATOR
    • DSM V DIAGNOSIS LIMITS
    • CONSERVATEE INTERVIEW
    • HISTORY OF DECOMPENSATION AND LACK OF INSIGHT
    • WRAPPING IT ALL TOGETHER AND CREATING THE NEXUS BETWEEN SYMPTOMS, HISTORY, COMPLIANCE, THIRD PARTY ASSISTANCE TO PROOF OF CURRENT GRAVE DISABILITY BEYOND A REASONABLE DOUBT
  • JUVENILE DEPENDENCY
    • FAST TRACK DEPENDENCY
    • DEPENDENCY APPEALS
    • DETENTION
    • JURISDICTION DISPOSITION (JURIS/DISPO)
    • §366.26 Hearing: Selection and Implementation
    • 730 Evaluators
    • Case Plan
  • New Updates
    • Right to Choose