Involuntary patients' right to refuse medication: impact of the Riese decision on a California inpatient unit.

R. L. Binder and D. E. McNiel,
Bull. Amer. Acad. Psychiatry & the Law 19(4): 351-7, 1991.
On June 22, 1989, the California Supreme Court allowed the Appellate Court decision in the right to refuse treatment case, Riese v. St. Mary's Hospital to stand. The court ruled that absent a judicial determination of incompetence, antipsychotic drugs cannot be administered to involuntarily committed mental patients in non-emergency situations without their informed consent. Much concern was expressed by the California Psychiatric Association and the California Alliance for the Mentally Ill about the decision's negative impact on patient care. In this paper, the authors review the decision, elucidate the anticipated concerns about the impact of the decision, and then describe the decision's actual impact on an acute inpatient unit in California. The authors report that Riese hearings were held on 7 percent of admissions to their locked inpatient facility. Only 1 percent of the patients were found to be competent to refuse medications. The authors give clinical examples of patients who were affected by the Riese decision and review the benefits and risks of this decision from the perspective of actual clinical practice.