BOP Program Statement 6010.03 § 7

MEDICATION

§ 549.46 Procedures for involuntary administration of psychiatric medication.

Except as provided in paragraph (b) of this section, the Bureau will follow the

administrative procedures of paragraph (a) of this section before involuntarily

administering psychiatric medication to any inmate.

Any use of force under this provision must comply with the procedures in the Program Statement

Use of Force and Application of Restraints.

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(a) Procedures. When an inmate is unwilling or unable to provide voluntary

written informed consent for recommended psychiatric medication, the inmate will

be scheduled for an administrative hearing. The hearing will provide the following

procedural safeguards:

(1) Unless an exception exists as provided in paragraph (b) of this section, the

inmate will not be involuntarily administered psychiatric medication before the

hearing.

(2) The inmate must be provided 24-hours advance written notice of the date,

time, place, and purpose of the hearing, including an explanation of the reasons

for the psychiatric medication proposal.

Use form BP-A0959, “Notice of Hearing and Advisement of Rights for Involuntary

Hospitalization or Medication for Psychiatric Care or Treatment,” to provide notice to the inmate.

This form is filled out only by the referring psychiatrist currently involved in the diagnosis or

treatment of the inmate. Any staff member may deliver a copy of the notice to the inmate.

(3) The inmate must be informed of the right to appear at the hearing, to present

evidence, to have a staff representative, to request witnesses, and to request that

witnesses be questioned by the staff representative or by the person conducting

the hearing. If the inmate does not request a staff representative, or requests a

staff representative with insufficient experience or education, or one who is not

reasonably available, the institution mental health division administrator must

appoint a qualified staff representative.

The BP-A0959 form used to provide notice to the inmate also advises the inmate of his/her rights

regarding evidence, witnesses, and staff representatives.

Inmates are entitled to appear at the hearing; however, at the discretion of the hearing psychiatrist,

the appearance requirement may be met by videoconference. Teleconference is not permissible,

as it does not allow the hearing psychiatrist to visually evaluate the inmate.

The assisting staff member’s responsibility is limited to helping the inmate obtain copies of

documents needed, for example, from his/her central file or other reasonably available source(s),

or a written statement(s) from reasonably available inmates or staff. The staff representative also

helps the inmate prepare and submit an appeal if he/she requests assistance, or wishes to appeal

but is unable to prepare and submit the appeal (see subsection b(9)).

(4) The hearing is to be conducted by a psychiatrist other than the attending

psychiatrist, and who is not currently involved in the diagnosis or treatment of the

inmate.

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The hearing may be conducted via videoconference by a psychiatrist who is not physically

located at the institution that currently houses the inmate. When the hearing is conducted via

videoconference, the hearing is considered to be held at the location of the inmate, not the

location of the hearing psychiatrist.

(5) Witnesses should be called if they are reasonably available and have

information relevant to the inmate’s mental condition or need for psychiatric

medication. Witnesses who will provide only repetitive information need not be

called.

Witnesses are not required to appear at the hearing in person. If reasonably available, witnesses

may appear via video- or teleconference, or may submit a written statement.

(6) A treating/evaluating psychiatrist/clinician, who has reviewed the case, must

be present at the hearing and must present clinical data and background

information relative to the inmate’s need for psychiatric medication. Members of

the treating/evaluating team may also be called as witnesses at the hearing to

provide relevant information.

The treating/evaluating psychiatrist/clinician may present clinical data and background

information relative to the inmate’s need for psychiatric medication via video- or teleconference,

or in person.

(7) The psychiatrist conducting the hearing must determine whether involuntary

administration of psychiatric medication is necessary because, as a result of the

mental illness or disorder, the inmate is dangerous to self or others, poses a

serious threat of damage to property affecting the security or orderly running of

the institution, or is gravely disabled (manifested by extreme deterioration in

personal functioning).

(8) The psychiatrist must prepare a written report regarding the initial decision.

The inmate must be promptly provided a copy of the initial decision report, and

informed that he/she may appeal it to the institution’s mental health division

administrator. The inmate’s appeal, which may be handwritten, must be submitted

within 24 hours after receipt of the hearing officer’s report. Upon request of the

inmate, the staff representative will assist the inmate in preparing and submitting

the appeal.

The psychiatrist conducting the hearing uses form BP-A0961, “Hearing Report: Involuntary

Medication for Psychiatric Care or Treatment,” to prepare the written report regarding the initial

medication decision.

The hearing psychiatrist must indicate the manner in which the hearing was held (in person or

videoconference) on the appropriate section of the hearing report form. At the end of the hearing

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the hearing psychiatrist advises the inmate of his/her appeal rights and informs the inmate of the

specific evidence relied upon in making the determination, the findings, and their justification.

The inmate is also advised of the right to appeal the decision to the institution mental health

division administrator within 24 hours of receipt of the hearing report. Any staff member may

deliver a copy of the hearing report to the inmate.

(9) If the inmate appeals the initial decision, psychiatric medication must not be

administered before the administrator issues a decision on the appeal, unless an

exception exists as provided in paragraph (b) of this section. The inmate’s appeal

will ordinarily be reviewed by the administrator or his designee within 24 hours of

its submission. The administrator will review the initial decision and ensure that

the inmate received all necessary procedural protections, and that the justification

for administering psychiatric medication is appropriate.

The form used for appeals is BP-A0962, “Appeal of Involuntary Hospitalization or Medication

Decisions for Psychiatric Care or Treatment.” The staff representative who participated in the

involuntary medication hearing assists the inmate in filing an appeal, if necessary.

(10) If an inmate was afforded an administrative hearing which resulted in the

involuntary administration of psychiatric medication, and the inmate subsequently

consented to the administration of such medication, and then later revokes his

consent, a follow-up hearing will be held before resuming the involuntary

administration of psychiatric medication. All such follow-up hearings will fully

comply with the procedures outlined in paragraphs (a)(1) through (10) of this

section.

(b) Exceptions. The Bureau may involuntarily administer psychiatric medication

to inmates in the following circumstances without following the procedures

outlined in paragraph (a) of this section:

Any use of force under this provision must comply with the procedures in the Program Statement

Use of Force and Application of Restraints.

(1) Psychiatric emergencies.

(i) During a psychiatric emergency, psychiatric medication may be administered

only when the medication constitutes an appropriate treatment for the mental

illness or disorder and its symptoms, and alternatives (e.g., seclusion or physical

restraint) are not available or indicated, or would not be effective. If psychiatric

medication is still recommended after the psychiatric emergency, and the

emergency criteria no longer exist, it may only be administered after following the

procedures in §§ 549.44 or 549.46 of this subpart.

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(ii) For purposes of this subpart, a psychiatric emergency exists when a person

suffering from a mental illness or disorder creates an immediate threat of:

(A) Bodily harm to self or others;

(B) Serious destruction of property affecting the security or orderly running of the

institution; or

(C) Extreme deterioration in personal functioning secondary to the mental illness

or disorder.

(2) Court orders for the purpose of restoring competency to stand trial.

Absent a psychiatric emergency as defined above, § 549.46(a) of this subpart does

not apply to the involuntary administration of psychiatric medication for the sole

purpose of restoring a person’s competency to stand trial. Only a federal court of

competent jurisdiction may order the involuntary administration of psychiatric

medication for the sole purpose of restoring a person’s competency to stand trial.

(i) Retention of Court Orders and Documentation. All court orders requiring the involuntary

administration of medication for the sole purpose of restoring competency must be retained in the

inmate health record. Staff at examining facilities are encouraged to keep a log of time, date, and

type of contact for all communication and correspondence related to the order, such as calls to

attorneys, and letters to or from the court. This log will help ensure that Bureau staff maintain

compliance with court orders originating in the jurisdiction of the court action.

(ii) Compliance with Court Orders. Bureau staff must continue to comply with a court order

requiring the involuntary administration of medication. If an inmate’s medical condition changes,

the treating physician should promptly consult with the Regional Medical Director, as well as

Regional Counsel and staff at the Consolidated Legal Center, for legal assistance and possible

consultation with the prosecuting United States Attorney’s Office.

REFERENCES

Program Statements

P5212.07 Control Unit Programs (2/20/01)

P5310.12 Psychology Services Manual (03/07/95)

P5310.13 Mentally Ill Inmates, Institution Management of (03/31/95)

P5566.06 Use of Force and Application of Restraints (11/30/2005)

P6010.02 Health Services Administration (01/15/05)

P6340.04 Psychiatric Services (01/15/05)

Federal Regulations

Rules cited in this Program Statement: 28 CFR §§ 549.40 through 549.46.

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ACA Standards

■ Standards for Adult Correctional Institutions, 4th Edition: 4-4348, 4-4372, 4-4374, 4-4397M,

4-4399, 4-4401M, 4-4404

■ Performance Based Standards for Adult Local Detention Facilities, 4th Edition: 4-ALDF-4C-

05, 4-ALDF-4C-31, 4-ALDF-4C-34, 4-ALDF-4D15M, 4-ALDF-4C-40, 4-ALDF-4D-17M, 4-

ALDF-4D-20

BOP Forms

Various Consent to Use (name of psychiatric medication)

BP-A0801 Consent to Admission for Mental Health Treatment

BP-A0959 Notice of Hearing and Advisement of Rights for Involuntary Hospitalization or

Medication for Psychiatric Care or Treatment

BP-A0960 Hearing Report: Involuntary Hospitalization for Psychiatric Care or Treatment

BP-A0961 Hearing Report: Involuntary Medication for Psychiatric Care or Treatment

BP-A0962 Appeal of Involuntary Hospitalization or Medication Decisions for Psychiatric Care

or Treatment

Records Retention Requirements

Requirements and retention guidance for records and information applicable to this program are

available in the Records and Information Disposition Schedule (RIDS) on Sallyport.

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