Committee hears bill to standardize involuntary psychiatric medication and cut post-restoration evaluations

SB465 would codify the process by which treating psychiatrists seek court permission to involuntarily administer psychiatric medication to defendants committed to the custody of the Division of Public and Behavioral Health (DPH) for restoration to competency and would change the number of post-restoration competency evaluations from three to two when the first two evaluators agree.

The bill was presented to the Nevada State Senate Judiciary Committee by Drew Cross, state forensic program director for the Division of Public and Behavioral Health, who said the measure “codifies U.S. Supreme Court case law and delineates the process most Nevada courts presently follow.” Cross told the committee the two-part bill both clarifies the court‑order process for involuntary medication aimed at restoring competency and reduces the number of required evaluations from three to two when both evaluators concur.

Supporters of the change argued it would increase efficiency without reducing safeguards. “Simply put, it is more efficient to clinicians, the clients, and the courts to reduce the number of total evaluations required per client from 3 to 2 and is reflective of the current perspective nationwide,” Cross said. He and other presenters emphasized that when the two evaluators disagree, a third evaluator would be assigned.

Why it matters: The measure affects the procedures and protections for defendants deemed incompetent to stand trial who are in DPH custody for restoration. It also touches on the narrow but legally significant distinction between emergency medication for safety and court‑ordered medication to restore competency.

What the bill does and how it would operate - Court orders: SB465 formalizes that a treating psychiatrist must submit a report and move the court for a hearing before involuntary administration of medication intended specifically to restore competency. Presenters repeatedly distinguished that emergency medication for immediate safety operates under Harper‑type case law and is administered on the unit without a court order; SB465 would not change that emergency pathway. - Evaluations: Under current practice many facilities require three evaluations after restoration treatment. The bill would require two evaluations when those two agree; if they disagree, a third evaluator would be assigned. - Clinical standards: Presenters said prescribing decisions would remain clinical judgments made by certified forensic psychiatrists, using the least invasive medication at the lowest effective dose and titrating as needed. Drew Cross said nurses administer medication in a controlled forensic hospital environment, with the presence of peace officers when required.

Concerns raised at the hearing - Duration and review of orders: Paloma Guerrero of the Clark County Public Defender's Office told the committee that section 1, subsection 5, as drafted would allow orders to “continue in full force and effect through the final adjudication in the criminal action,” which Guerrero said could leave defendants subject to involuntary medication for years without routine review. “Jails often don't have the same prescription ability that Lakes and Stein have,” Guerrero said, noting differences in monitoring and lab work between forensic hospitals and jails. She urged a mechanism for periodic review rather than an indefinite order. - Evaluator independence and expertise: Both the Clark and Washoe county public defenders (Paloma Guerrero and Angela Knott) said one evaluator being a member of the treatment team can be important because team clinicians know the patient’s delusions and history. Jennifer Noble of the Nevada District Attorneys Association said she opposed a provision that would categorically exclude a treatment-team member, citing workforce availability and the value of treatment-team insight.

Responses and next steps - The presenters, including Rhonda Dillinger, deputy administrator of clinical services, said they are open to revising the evaluator‑membership language and are coordinating with stakeholders to finalize wording. Dillinger: “We're open to changing that. And so we've been working on the wording. And as soon as we kinda finalize our wording internally, we'll be sending it out to the stakeholders, the public defenders, and district attorneys to get their feedback.” - Committee members asked for data about frequent utilizers of forensic services and medication adherence. Drew Cross said the division does track a “narrow group of individuals who frequently utilize our services” where medication adherence is an ongoing issue and offered to provide that data to the committee.

Process and safeguards emphasized at the hearing - Emergency vs. restoration medication: Presenters consistently distinguished emergency medication for immediate safety (administered on the unit under Harper‑type case law) from court‑ordered medication to restore competency (the subject of SB465). The bill would not remove the requirement for a court order before involuntary administration in the restoration context. - Least invasive approach: Presenters described a treatment‑team model that seeks the least invasive means to restore competency — education, legal‑process classes, assignment of a sponsor, and other individualized interventions before resorting to forced medication.

Ending The committee heard several representatives from public defender offices and the Nevada District Attorneys Association express objections to specific provisions in SB465, chiefly the potential for indefinite orders and the proposed rule about evaluator membership on treatment teams. The DPH presenters said they are working with stakeholders to refine language, and no formal committee vote on SB465 was recorded in the hearing transcript. The bill will proceed with stakeholder negotiation on the two primary contested points: (1) a review or sunset mechanism for medication orders and (2) the precise requirement about whether evaluators may be members of a defendant's treatment team.