SOP_NUMBER: 508.26
TITLE: Involuntary Medication Administration
REFERENCE_CODE: VG66-0001
WORD_COUNT: 3397
POWERDMS_URL: https://public.powerdms.com/GADOC/documents/106288
URL: https://gps.press/sop-data/508.26/

ATTACHMENTS:
  1. Involuntary Medication Order Check Sheet
     URL: https://gps.press/sop-data/508.26-att-1/
  2. Physician Opinion for Involuntary Medication
     URL: https://gps.press/sop-data/508.26-att-2/
  3. Notification of Involuntary Medication Due Process Committee Hearing
     URL: https://gps.press/sop-data/508.26-att-3/
  4. Involuntary Medication Rights of Offender
     URL: https://gps.press/sop-data/508.26-att-4/
  5. Mental Health Due Process Committee Involuntary Medication Review
     URL: https://gps.press/sop-data/508.26-att-5/
  6. Involuntary Medication Hearing Log
     URL: https://gps.press/sop-data/508.26-att-6/
  7. Notification of Involuntary Medication Due Process Committee Decision
     URL: https://gps.press/sop-data/508.26-att-7/

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|GEORGIA DEPARTMENT OF CORRECTIONS<br>Standard Operating Procedures|Col2|Col3|
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|<br> <br>**Policy Name:**Involuntary Medication Administration|<br> <br>**Policy Name:**Involuntary Medication Administration|<br> <br>**Policy Name:**Involuntary Medication Administration|
|<br> <br>**Policy Number:**  508.26|**Effective Date:** 8/8/2023|**Page Number:** 1 of 12|
|<br> <br> <br>**Authority:** <br>Commissioner<br>|**Originating Division:** <br>Health Services Division<br>(Mental Health)|**Access Listing:**<br>Level II: Required<br>Offender Access|



**I.** **Introduction and Summary:**

It is the policy of the Georgia Department of Corrections (GDC) to seek voluntary
participation from offenders on the mental health caseload for whom psychotropic
medication has been prescribed. The offender has the right to refuse medication
except under those conditions described in this procedure.

**II.** **Authority:**

A. O.C.G.A.: 37-3-163 and 37-3-81.

B. GDC Standard Operating Procedure (SOP): 209.04 Use of Force and Restraint

for Offender Control.

C. ACA Standards: 5-ACI-6C-04 (Mandatory), 5-ACI-6C-08 (Mandatory), and 4
ALDF-4D-15 (Mandatory).

D. National Commission on Correctional Health Care (NCCHC) Standards for

Health Services in Prisons.

E. NCCHC Standards for Health Services in Juvenile Detention and Confinement

Facilities; and

F. _Washington v. Harper_, 110 S. Ct. 1028.

**III.** **Definitions:**

A. **Hearing Administrator**    - A mental health staff member who facilitates the

Involuntary Medication Due Process Committee through the hearing process,
ensuring that policy is followed. This role is usually filled by the mental health
unit manager or designee.

B. **Involuntary Medication Due Process Committee**    - Three people who are

selected from the facility staff, through coordination by the facility mental health


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|**Policy Name:**Involuntary Medication Administration|**Policy Name:**Involuntary Medication Administration|**Policy Name:**Involuntary Medication Administration|
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|**Authority:** <br>Commissioner<br>|**Originating Division:** <br>Health Services Division<br>(Mental Health)|**Access Listing:**<br>Level II: Required Offender<br>Access|



unit manager, to act as decision makers regarding involuntary medication
administration at a due process hearing. The three people will include a deputy
warden of care and treatment or designee, a professional member of the mental
health staff (counselor or mental health technician) and a medical staff member
(registered nurse (RN), advanced practice registered nurse (APRN), physician’s
assistant (PA) or physician). The committee members cannot have been directly
involved with recent mental health treatment or evaluation of the offender. Each
committee member has one equally weighted vote. The mental health unit
manager should not be a member of the committee. A designated recording
secretary will audio record the committee proceedings.

C. **Involuntary Medication Due Process Hearing**    - A meeting of assigned

Involuntary Medication Due Process Committee members to make an objective
decision by independent and impartial people, whether to provide involuntary
medication while protecting the rights of the offender.

D. **Offender Advocate**    - A mental health counselor assigned by the mental health

unit manager to explain the rights to the offender and assist the offender to
verbalize reasons for refusing psychotropic medication during the due process
hearing. The Offender Advocate cannot be the offender's assigned counselor.

E. **Psychiatric Emergency**    - A crisis in which the offender is currently presenting

risk of harm to self or others, or unable to participate in their care or treatment
due to a decline in their functioning as a result of mental illness.

F. **State’s Advocate**    - A mental health counselor or mental health technician not

directly involved in the treatment of the offender, acts as the State’s Advocate
and presents documentary evidence, during the due process hearing.

**IV.** **Statement of Policy and Applicable Procedures:**

The purpose of these procedures is to guide options for treatment of an offender who
is unwilling to accept medication while affording offenders the right to due process
in contesting the administration of psychotropic medication prescribed by licensed
physicians authorized to prescribe such medications.


|GEORGIA DEPARTMENT OF CORRECTIONS<br>Standard Operating Procedures|Col2|Col3|
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|**Policy Name:**Involuntary Medication Administration|**Policy Name:**Involuntary Medication Administration|**Policy Name:**Involuntary Medication Administration|
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|**Authority:** <br>Commissioner<br>|**Originating Division:** <br>Health Services Division<br>(Mental Health)|**Access Listing:**<br>Level II: Required Offender<br>Access|



A. Conditions Under Which Medication May Be Administered Involuntarily:

Psychotropic medication may be administered against the offender’s refusal
under one or more of the following conditions:

1. Psychiatric Emergency:


a. The offender has a mental illness, that is, has a disorder of thought or

mood which significantly impairs judgment, behavior, the capacity to
recognize reality, or the ability to cope with the ordinary demands of life;
and

i. Presents a substantial risk of imminent harm to themselves, or others

as manifested by recent overt acts or recent expressed threats of
violence which present a high probability of physical injury to
themselves or to other persons; or

ii. Who is so unable to care for their own personal health or safety as to

create an imminently life-endangering crisis; or their inability to
participate in their treatment and less restrictive intervention options
have been exercised without success as determined by psychiatry
services.

b. Decanoate medications may not be given in an emergency unless the

offender is on “involuntary medication status” as granted by a previous
due process hearing committee.

i. Emergency involuntary medication may only be ordered one dose at a

time and may not be written as PRN (as needed).

ii. Pursuing an involuntary medication hearing is not mandatory if:


(a) Use of emergency medication occurs within a limited time frame

(24 hours) and does not occur again within 30 days.


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|**Authority:** <br>Commissioner<br>|**Originating Division:** <br>Health Services Division<br>(Mental Health)|**Access Listing:**<br>Level II: Required Offender<br>Access|



(b) The use of more than one dose of emergency medication ~~s~~ (short
acting injectable) during a 24-hour time frame to treat one episode
of urgent illness or emergent uncontrolled behavior such as serious
self-injurious behavior.

(c) Ongoing use of emergency medication is not anticipated in the

next 30 days.


**Note: If the treatment team determines that involuntary**

**medication is not clinically indicated prior to the hearing,**
**the process can be stopped.**


iii. Emergency involuntary medication may be administered until a due

process hearing occurs. This hearing must be scheduled after the 24hour time frame and within seven (7) days of the first opinion made
by the attending psychiatrist who initiates the involuntary medication
process.

2. Chronically Dangerous Seriously Mentally Ill:


a.  Psychotropic medication may also be administered against the

offender’s refusal under the following conditions:

i. When the offender refuses to accept medication, in the treatment of a

chronic psychiatric condition; and

ii. The offender has a documented history of becoming dangerous to self

or others without psychotropic medication.

B. Procedures for Placing an Offender on Involuntary Medication Status:


1. When an offender refuses to accept medication by verbal statement, written

statement, gesture, or silence in the treatment of a chronic psychiatric
condition and is currently (or historically when off medication) dangerous to


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|**Authority:** <br>Commissioner<br>|**Originating Division:** <br>Health Services Division<br>(Mental Health)|**Access Listing:**<br>Level II: Required Offender<br>Access|



self or others with no expectation of improvement, the attending physician
must then explain to the offender:


a. The assessment results.

b. The reason(s) for prescribing the medications.

c. When, where, and how the medication is to be administered.

d. The risks and benefits of taking the medications; and

e. The advantages and disadvantages of taking voluntary and involuntary

medications.

2. The physician will inform the offender that the medication may be given

involuntarily and for the duration of the pharmacological therapy.

3. The physician will inform the offender that the issue of involuntary

medications will be discussed in a meeting of the Mental Health Due Process
Committee.

4. Emergency involuntary medication may be administered until a due process

hearing occurs. This hearing must be scheduled after the 24-hour time frame
and within seven (7) days of the first opinion made by the attending physician
who initiates the involuntary medication process.

C. Within 14 working days of the offender being informed that medication may be

given involuntarily, the physician will request a second opinion on the need of
involuntary medication administration. The second opinion is to be done by
another physician and will be documented using the Physician Opinion for
Involuntary Medication (Attachment 2, form M66-01-02).

1. Both physician opinions should be documented no later than the 14-day time

frame.


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|**Authority:** <br>Commissioner<br>|**Originating Division:** <br>Health Services Division<br>(Mental Health)|**Access Listing:**<br>Level II: Required Offender<br>Access|



2. The physician will document the above steps using the Involuntary

Medication Order Check Sheet (Attachment 1, form M66-01-01), as a guide.
The physician will include documentation of how the offender satisfies IV.
A.1 or A.2, within this procedure, using the Physician Opinion for
Involuntary Medication (Attachment 2, form M66-01-02).


D. Mental Health Due Process Committee:


1. Each correctional facility with a mental health program will have its own

Mental Health Due Process Committee. The mental health unit manager at
the facility will appoint the committee.

2. The voting committee will be composed of three individuals:


a. The deputy warden of care and treatment/designee, but not the mental

health unit manager.

b. A professional member of the mental health staff who is not directly

involved in the offender's treatment.

c. A medical staff member who is not directly involved in the offender's

treatment (RN, APRN, PA, or physician)

3. Due Process Hearing:


a. The mental health unit manager or designee will coordinate the hearing

procedure. The mental health unit manager will also assign the State’s
Advocate and Offender Advocate. The mental health unit manager will
assemble an impartial due process hearing committee.

b. The mental health unit manager will arrange a time and location for the

hearing consistent with the timetables detailed in these procedures.


|GEORGIA DEPARTMENT OF CORRECTIONS<br>Standard Operating Procedures|Col2|Col3|
|---|---|---|
|**Policy Name:**Involuntary Medication Administration|**Policy Name:**Involuntary Medication Administration|**Policy Name:**Involuntary Medication Administration|
|**Policy Number:** 508.26|**Effective Date:** 8/8/2023|**Page Number:** 7 of 12|
|**Authority:** <br>Commissioner<br>|**Originating Division:** <br>Health Services Division<br>(Mental Health)|**Access Listing:**<br>Level II: Required Offender<br>Access|



c. The assigned Offender Advocate will notify the offender of the time and

location of the hearing using the Notification of Involuntary Medication
Committee Hearing (Attachment 3, form M66-01-03). The Offender
Advocate will explain the offender's rights using the Involuntary
Medication Rights of Offenders (Attachment 4, form M66-01-04). Copies
of both forms will be provided to the offender.

d. Upon request, the GDC’s Office of Legal Services will provide

consultation and direction, as needed, through the process.

e. Attorney advocates retained by the offender will be allowed to visit with

the offender consistent with the Georgia Compilation of Rules &
Regulations 125-03-04-.07. It will be the responsibility of the GDC to
notify the offender's privately retained attorney of the time and location
set for the hearing. The records and documentation will be made available
to the attorney advocate.

f. The purpose of the impartial due process hearing will be to determine

whether the offender has a mental illness and has a condition that meets
the criteria described in Section IV. A. 1 or A. 2 of this procedure.

g. The State’s Advocate will be responsible for presenting all evidence from

documented information, including a written summary of key history
relevant to the need for involuntary medication, and psychiatry findings
regarding evaluation of history, mental status, and opinion, on need for
medication.

h. The highest-ranking administrative member of the committee will be

appointed “Hearing Officer” and guide the process of the hearing.

i. The Offender Advocate will provide representation to the offender in

expressing their reasons for not requiring medication. The offender's
attorney will serve this role if present. However, the attorney’s presence


|GEORGIA DEPARTMENT OF CORRECTIONS<br>Standard Operating Procedures|Col2|Col3|
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|**Policy Name:**Involuntary Medication Administration|**Policy Name:**Involuntary Medication Administration|**Policy Name:**Involuntary Medication Administration|
|**Policy Number:** 508.26|**Effective Date:** 8/8/2023|**Page Number:** 8 of 12|
|**Authority:** <br>Commissioner<br>|**Originating Division:** <br>Health Services Division<br>(Mental Health)|**Access Listing:**<br>Level II: Required Offender<br>Access|



does not eliminate the possible need for support from the Offender
Advocate.

j. The offender has the right to attend the hearing. The offender or the

offender’s representative has the right to call any person as a witness
including people located at other institutions unless reasonable cause
exists not to allow this. Said reasons will be documented. However, at the
discretion of the hearing officer, such testimony may be taken by phone
or in writing, on condition that the offender provides written questions to
be asked of the witness(s).

k. The offender or their representative may question and cross-examine

witnesses called by the GDC, except upon the finding by the Hearing
Officer that reasonable cause exists not to allow cross examination. Said
reasons will be documented in the record. In the event of such a finding,
the offender or his/her representative may submit to the Hearing Officer
questions to be asked of such witnesses.

l. The Hearing Officer will admit all relevant evidence. The Hearing Officer

may limit evidence that is merely cumulative. In the event, however, that
admissible evidence is found to be cumulative, the offender or their
representative may select the evidence they wish to introduce among the
cumulative sources of otherwise admissible evidence. A designated
recording secretary will record the proceedings before the Hearing
Officer. The mental health unit manager will keep the recording of the
hearing proceedings for at least two (2) years from the date of the
hearing.

m. After the Committee has received all pertinent information, all non
committee participants will be excused while the committee deliberates in
private regarding the testimony presented.

n. If, after the committee’s deliberation, it finds that criteria for involuntary

medication administration are met, it will issue its findings in writing


|GEORGIA DEPARTMENT OF CORRECTIONS<br>Standard Operating Procedures|Col2|Col3|
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|**Policy Name:**Involuntary Medication Administration|**Policy Name:**Involuntary Medication Administration|**Policy Name:**Involuntary Medication Administration|
|**Policy Number:** 508.26|**Effective Date:** 8/8/2023|**Page Number:** 9 of 12|
|**Authority:** <br>Commissioner<br>|**Originating Division:** <br>Health Services Division<br>(Mental Health)|**Access Listing:**<br>Level II: Required Offender<br>Access|



using the Mental Health Due Process Committee Involuntary Medication
Review (Attachment 5, form M66-01-05), affirming the appropriateness
of the involuntary medication. If criteria have not been met, the
committee will issue its findings to that effect in writing, using the Mental
Health Due Process Committee Involuntary Medication Review
(Attachment 5, form M66-01-05), and involuntary medication may not be
administered.

o. The documentation of the proceedings will include the offender's most

recent treatment plan, the offender's reasons for refusal, efforts made by
staff to obtain the offender's medication adherence, and rationale for the
conclusion reached by the committee, as well as other pertinent data
related to the decision to involuntarily medicate the offender.

p. Decisions to continue involuntary medication status require a rehearing

process every six (6) months. If the six (6) month involuntary medication
status expires, involuntary treatment for chronic conditions should be
delayed until there is another involuntary hearing. The rehearing process
will follow the above steps in this section (IV.D.3).

q. The mental health unit manager will keep an Involuntary Medication

Hearing Log (Attachment 6, form M66-01-06).

4. Notification of the Committee Decision:


The Offender Advocate will provide a copy of the decision to the offender
within two (2) working days of the hearing using the Notification of
Involuntary Medication Committee Decision (Attachment 7, form M66-0107).

5. Involuntary Medication Administration:


a. The offender will be closely monitored to ensure there are no adverse

reactions and side effects.


|GEORGIA DEPARTMENT OF CORRECTIONS<br>Standard Operating Procedures|Col2|Col3|
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|**Authority:** <br>Commissioner<br>|**Originating Division:** <br>Health Services Division<br>(Mental Health)|**Access Listing:**<br>Level II: Required Offender<br>Access|



b. Efforts will be made to counsel the offender about compliance with an

involuntary medication order without use of force. Voluntary acceptance
will not negate the involuntary status of the medication order.

c. When medication is administered involuntarily, security staff will use

only the minimum force needed. A Use of Force report will be completed
in accordance with department guidelines (SOP 209.04).

d. The Mental Health Nurse will document any need for use of force or

coercion in a progress note that will be placed in the mental health section
five (5) of the medical record.

e. Nursing staff will clearly label the offender's medication administration

record (MAR) with the phrase “Involuntary Medication Status.”

6. Documentation (Filing):


The following documentation of the actions surrounding the hearing will be
packaged (stapled together as a unit). The original package will be filed in the
mental health section five (5) of the medical record. A copy of the package
will be filed in the mental health record section five (5). The documentation
package will include the following:

a. Involuntary Medication Order Check List (Attachment 1, form M66-01
01).

b. Physician Opinion for Involuntary Medication (Attachment 2, form M66
01-02), and/or psychiatric progress notes by the ordering physician and/or
second opinion by physician regarding need for involuntary medication.

c. Notification of Involuntary Medication Committee Hearing (Attachment

3, form M66-01-03).


|GEORGIA DEPARTMENT OF CORRECTIONS<br>Standard Operating Procedures|Col2|Col3|
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|**Policy Name:**Involuntary Medication Administration|**Policy Name:**Involuntary Medication Administration|**Policy Name:**Involuntary Medication Administration|
|**Policy Number:** 508.26|**Effective Date:** 8/8/2023|**Page Number:** 11 of 12|
|**Authority:** <br>Commissioner<br>|**Originating Division:** <br>Health Services Division<br>(Mental Health)|**Access Listing:**<br>Level II: Required Offender<br>Access|



d. Involuntary Medication Rights of Offender (Attachment 4, form M66-01
04).

e. Mental Health Due Process Committee Involuntary Medication Review

(Attachment 5, form M66-01-05).

f. Notification of Involuntary Committee Decision (Attachment 7, form

M66-01-7); and

g. A copy of any progress notes which were used as evidence during the due

process hearing.

7. After the Six (6) Month Interval:


If at the six (6) month interval following a due process hearing, the offender
continues to meet the above criteria, another due process hearing will be
necessary.

a. If, based on history, the offender continues to meet the above criteria but

is willing to take medication voluntarily, the due process hearing is still
necessary at the six (6) month interval. At this time a decision will be
made to either extend or suspend the administration of involuntary
medication.

b. Prior to deciding to discontinue the prescribed medications or deciding to

allow the offender to take voluntary medication by mouth, the attending
physician shall discuss the decision with the offender's treatment team
and document the discussion. Less restrictive treatment alternatives
should be used as soon as possible and documented in the treatment plan.
Treatment plan goals are prepared for less restrictive or less invasive
treatment alternatives with return to voluntary treatment, as soon as
clinically feasible.


|GEORGIA DEPARTMENT OF CORRECTIONS<br>Standard Operating Procedures|Col2|Col3|
|---|---|---|
|**Policy Name:**Involuntary Medication Administration|**Policy Name:**Involuntary Medication Administration|**Policy Name:**Involuntary Medication Administration|
|**Policy Number:** 508.26|**Effective Date:** 8/8/2023|**Page Number:** 12 of 12|
|**Authority:** <br>Commissioner<br>|**Originating Division:** <br>Health Services Division<br>(Mental Health)|**Access Listing:**<br>Level II: Required Offender<br>Access|



c. The licensed physician who prescribes medication to be administered

involuntarily must ascertain the medication:


i. Is consistent with the accepted treatment for the offender's

diagnosis(s) and symptoms; and

ii. Is expected to provide an effective treatment response for the

offender's diagnosis(s) and symptoms.

**V.    Attachments:**

Attachment 1: Involuntary Medication Order Check Sheet (M66-01-01)
Attachment 2: Physician Opinion for Involuntary Medication (M66-01-02)
Attachment 3: Notification of Involuntary Medication Due Process Committee

Hearing (M66-01-03)
Attachment 4: Involuntary Medication Rights of Offender (M66-01-04)
Attachment 5: Mental Health Due Process Committee Involuntary Medication

Review (M66-01-05)
Attachment 6: Involuntary Medication Hearing Log (M66-01-06)
Attachment 7: Notification of Involuntary Medication Due Process Committee

Decision (M66-01-07)

**VI.** **Record Retention of Forms Relevant to this Policy:**

Upon completion, Attachments 1-5 and 7 will be placed in the offender’s mental
health record section five (5) and medical record, section five (5). At the end of the
offender’s need for mental health services and/or sentence, the mental health record
will be placed within the offender’s health record and retained for 10 years.
Attachment 6 will be maintained in the mental health area for four (4) years then
replaced or archived.