SECTION 414.410. Psychiatric Emergencies

(a) Nothing in this subchapter is intended to preclude the administration of psychoactive medication to any patient in a psychiatric emergency.

(b) If a physician issues an order to administer psychoactive medication to a patient without the patient's consent because of a psychiatric emergency, then the physician will document in the patient's clinical record in specific medical or behavioral terms:

(1) why the order is necessary:

(2) other generally accepted, less intrusive forms of treatment, if any, that the physician has evaluated but rejected; and

(3) the reasons those treatments were rejected.

(c) Treatment of the patient with the psychoactive medication will be provided in the manner, consistent with clinically appropriate medical care, least restrictive of the patient's personal liberty.

(d) A brief physical hold is not considered restraint for purposes of this subchapter provided that:

(1) the individual currently exhibits behavior that meets the definition of psychiatric emergency as defined in this subchapter, or the individual is currently under a court order allowing the facility to administer medication without consent of the individual, the individual is refusing medication, and the medication ordered is permitted by the court order;

(2) the purpose of administering medication is active treatment to reduce symptoms of a diagnosed mental illness;

(3) using medication to reduce specified symptoms of a diagnosed mental illness is standard clinical practice;

(4) the specific medication and dosage ordered can be clinically justified as in keeping with standard clinical practice and are appropriate for reduction of specified target symptoms; and

(5) the physical hold is terminated as soon as the medication is administered.

(e) When the psychiatric emergency is no longer imminent or present, medication prescribed without consent on an emergency basis must be safely discontinued. If continued use of medication is recommended on a regular basis, the physician must comply with provisions outlined in §414.406 of this title (relating to Patients Admitted Under Texas Statutes), §414.407 of this title (relating to Patients Committed to Mental Health Facilities Under Provisions of the Texas Health and Safety Code), or §414.408 of this title (relating to Patients Committed to Mental Health Facilities under Provisions Other than Those Found in the Texas Health and Safety Code (i.e., Code of Criminal Procedure, Family Code)), as appropriate.

(f) In no case may inappropriate designation of a situation as a psychiatric emergency be used to circumvent the process of obtaining consent or applying to the court for an order authorizing administration of psychoactive medication.

Source Note: The provisions of this §414.410 adopted to be effective August 31, 2004, 29 TexReg 8317