The impact of judicial review of patients' refusal to accept antipsychotic medications
at the Minnesota Security Hospital.
M. G. Farnsworth,
Bull. Amer. Acad. Psychiatry & the Law
19(1): 33-42, 1991.
In 1988, the Minnesota Supreme Court ruled that premedication judicial review was required to force
antipsychotic medications on incompetent committed patients in Minnesota. Before this decision all
patients refusing antipsychotic medications at state hospitals were reviewed by an internal
multidisciplinary peer review organization called the Treatment Review Panel (TRP). The author
examined the impact of judicial review of medications at the Minnesota Security Hospital.
Thirty-one patients reviewed by the Treatment Review Panel (TRP) between July 1986 and
December 1987 were compared with 37 patients reviewed by the TRP and the court between January
1988 and December 1989. There was nearly unanimous agreement between the TRP and the court
in approving antipsychotic medications for patients. However, for patients awaiting judicial review
for medication, an average delay of 80 days was encountered, and there was a significant increase
in the number of emergencies occurring on the treatment unit before the initiation of treatment.
Complications of the long delay in approving medications included the diversion of limited mental
health money to cover the costs of judicial review, diversion of physicians from direct patient care
to provide testimony, inconsistent judicial medication and monitoring decisions, and compromise
of medical judgment to meet judicial requirements. The study concluded that there was no advantage
of judicial review over the previous Treatment Review Panel function.