Counsel’s Corner

Right of People to Refuse Psychotropic Medications

By PWDF Staff

People With Disabilities Foundation obtained a judgment against the Social Security Administration (SSA) in federal court in the Northern District of California because the SSA illegally used plaintiff’s right to decline ingesting psychotropic medications to find her “not disabled” for social security disability benefits. This has been and remains an important disability rights issue also applying to inpatients for at least the last 50 years. See M.F. v. SSA, Case No.: 3:20-CV-8742 WHA (N.D. Cal.).

At the hearing before the SSA administrative law judge (ALJ), plaintiff’s testimony about her major depressive disorder and post-traumatic stress disorder, and the clinical record substantiates treatment notes from two treating psychologists and one psychological consultative examiner.

Plaintiff’s position is she has not pursued medication to relieve her symptoms due to a general sensitivity to medication and a family history of adverse reactions to antidepressants.  As an alternative to drugs, she has used psychotherapy.

Plaintiff argued that the ALJ committed legal error by discounting her symptoms because of her refusal to take psychotropic drugs without also addressing her explanation for such refusal.  The federal judge agreed. The Court stated:

‘…Our court of appeals has noted “the side effects of medications can have a significant impact on an individual’s ability to work and should figure in the disability determination process.” Varney v. Sec. of Health & Hum. Servs., 846 F.2d 581, 585 (9th Cir.), modified on rehearing on other grounds, 859 F.2d 1396 (1988). The ALJ discounted plaintiff’s symptom testimony primarily because of her lack of medication and resultant conservative treatment regimen. Yet the ALJ failed to consider plaintiff’s explicit explanation for her refusal to take medication. This omission was error. the [sic] ALJ cannot rely on plaintiff’s refusal to take medication to justify discounting her symptom testimony without assessing plaintiff’s reasons for that refusal.’

The ALJ repeatedly emphasized plaintiff’s lack of drug regimen throughout the opinion.  But despite the notable reliance on plaintiff’s lack of medication, the ALJ’s decision failed to include any review of plaintiff’s stated “medical sensitivity” to psychiatric drugs, which is a clear legal error.

Plaintiff stated that her mother was put on antidepressants that led to bleeding in her stomach, for which she was hospitalized, and that she eventually died from gastrointestinal bleeding directly related to the medication (of which she had no history prior).  Plaintiff stated she is sensitive and generally gets most of the same side effect, so taking medication was of great concern.

The federal court stated that the ALJ failed to consider plaintiff’s explicit explanation for her refusal to take medication, and this omission was legal error. The ALJ cannot rely on plaintiff’s refusal to take medication to justify discounting her symptom testimony without assessing plaintiff’s reasons for that refusal.  The Court found the ALJ’s failure to address plaintiff’s justification for refusing a drug regimen to treat her is a reversible error and fails to satisfy the clear and convincing evidence standard.

The order found remand would enable the ALJ to provide a more definitive explanation for why plaintiff’s assertion that she suffers severe side effects from psychiatric drugs did not meet the legal standard.

The remand order in no way suggests that the ALJ should change her mind, rather, the remand is ordered based on reversible legal error.

People have a right to refuse medication and still be eligible for social security disability benefits so long as it is not based on malingering behavior which would meet the “clear and convincing” standard and thereby discount plaintiff’s testimony.

Who We Are

People With Disabilities Foundation is an operating 501(c)(3) nonprofit organization based in San Francisco, California, which focuses on the rights of the mentally and developmentally disabled.

Services

Advocacy: PWDF advocates for Social Security claimant’s disability benefits in eight Bay Area counties. We also provide services in disability rights, on issues regarding returning to work, and in ADA consultations, including areas of employment, health care, and education, among others. There is representation before all levels of federal court and Administrative Law Judges. No one is declined due to their inability to pay, and we offer a sliding scale for attorney’s fees.

Education/Public Awareness: To help eliminate the stigma against people with mental disabilities in society, PWDF’s educational program organizes workshops and public seminars, provides guest speakers with backgrounds in mental health, and produces educational materials such as videos.