HOUSE AMENDMENT
Bill No. CS/CS/SB 340
   
1 CHAMBER ACTION
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Senate House
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12          Representative Simmons offered the following:
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14          Amendment (with title amendments)
15          On page 2, line(s) 1,
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17          insert:
18          Section 2. Subsection (3) of section 394.455, Florida
19    Statutes, is amended, and subsections (31) and (32) are added to
20    said section, to read:
21          394.455 Definitions.--As used in this part, unless the
22    context clearly requires otherwise, the term:
23          (3) "Clinical record" means all parts of the record
24    required to be maintained and includes all medical records,
25    progress notes, charts, and admission and discharge data, and
26    all other information recorded by a facility which pertains to
27    the patient's hospitalization orandtreatment.
28          (31) "Service provider” means any public or private
29    receiving facility, entity under contract with the Department of
30    Children and Family Services to provide mental health services,
31    or a clinical psychologist, clinical social worker, physician,
32    psychiatric nurse, community mental health center, or clinic as
33    defined in this part.
34          (32) "Involuntary placement” means involuntary outpatient
35    treatment pursuant to s. 394.466 or involuntary inpatient
36    treatment pursuant to s. 394.467.
37          Section 3. Subsections (1) and (7) of section 394.4598,
38    Florida Statutes, are amended to read:
39          394.4598 Guardian advocate.--
40          (1) The administrator may petition the court for the
41    appointment of a guardian advocate based upon the opinion of a
42    psychiatrist that the patient is incompetent to consent to
43    treatment. If the court finds that a patient is incompetent to
44    consent to treatment and has not been adjudicated incapacitated
45    and a guardian with the authority to consent to mental health
46    treatment appointed, it shall appoint a guardian advocate. The
47    patient has the right to have an attorney represent him or her
48    at the hearing. If the person is indigent, the court shall
49    appoint the office of the public defender to represent him or
50    her at the hearing. The patient has the right to testify, cross-
51    examine witnesses, and present witnesses. The proceeding shall
52    be recorded either electronically or stenographically, and
53    testimony shall be provided under oath. One of the professionals
54    authorized to give an opinion in support of a petition for
55    involuntary placement, as described in s. 394.466 ors.
56    394.467(2), must testify. A guardian advocate must meet the
57    qualifications of a guardian contained in part IV of chapter
58    744, except that a professional referred to in this part, an
59    employee of the facility providing direct services to the
60    patient under this part, a departmental employee, a facility
61    administrator, or member of the Florida local advocacy council
62    shall not be appointed. A person who is appointed as a guardian
63    advocate must agree to the appointment.
64          (7) The guardian advocate shall be discharged when the
65    patient is discharged from an order for involuntary inpatient or
66    outpatient placement or as provided in s. 394.466(6)(d)a
67    receiving or treatment facility to the communityor when the
68    patient is transferred from involuntary to voluntary status. The
69    court or a hearing officer shall consider the competence of the
70    patient pursuant to subsection (1) and may consider an
71    involuntarily placed patient's competence to consent to
72    treatment at any hearing. Upon sufficient evidence, the court
73    may restore, or the hearing officer may recommend that the court
74    restore, the patient's competence. A copy of the order restoring
75    competence or the certificate of discharge containing the
76    restoration of competence shall be provided to the patient and
77    the guardian advocate.
78          Section 4. Paragraph (c) is added to subsection (3) of
79    section 394.4615, Florida Statutes, to read:
80          394.4615 Clinical records; confidentiality.--
81          (3) Information from the clinical record may be released
82    when:
83          (c) It is necessary to determine whether a person meets
84    the criteria for involuntary outpatient placement pursuant to s.
85    394.466. In such circumstance, the clinical record may be
86    released to the state attorney, public defender or the patient’s
87    private legal counsel, the court, and the appropriate mental
88    health professionals.
89          Section 5. Subsection (1) and paragraphs (e), (g), and (i)
90    of subsection (2) of section 394.463, Florida Statutes, are
91    amended to read:
92          394.463 Involuntary examination.--
93          (1) CRITERIA.--A person may be taken to a receiving
94    facility for involuntary examination if there is reason to
95    believe that the person has a mental illnesshe or she is
96    mentally illand because of his or her mental illness:
97          (a)1. The person has refused voluntary examination after
98    conscientious explanation and disclosure of the purpose of the
99    examination; or
100          2. The person is unable to determine for himself or
101    herself whether examination is necessary; and
102          (b) Based on the person’s current reported or observed
103    behavior, considering any mental health history, there is a
104    substantial likelihood that, without care or treatment:
105          1. Without care or treatment, The person willis likely to
106    suffer from neglect or refuse to care for himself or herself;
107    such neglect or refusal will poseposesa real and present
108    threat of substantial harm to his or her well-being; and it is
109    not apparent that such harm may be avoided through the help of
110    willing family members or friends or the provision of other
111    services; or
112          2. There is a substantial likelihood that without care or
113    treatmentThe person will cause serious bodily harm to himself
114    or herself or others in the near future, as evidenced by recent
115    behavior.
116          (2) INVOLUNTARY EXAMINATION.--
117          (e) The Agency for Health Care Administration shall
118    receive and maintain the copies of ex parte orders, involuntary
119    outpatient placement orders issued pursuant to s. 394.466, or
120    involuntary inpatient placement orders issued pursuant to s.
121    394.467,professional certificates, and law enforcement
122    officers' reports. These documents shall be considered part of
123    the clinical record, governed by the provisions of s. 394.4615.
124    The agency shall prepare annual reports analyzing the data
125    obtained from these documents, without information identifying
126    patients, and shall provide copies of reports to the department,
127    the President of the Senate, the Speaker of the House of
128    Representatives, and the minority leaders of the Senate and the
129    House of Representatives.
130          (g) A person for whom an involuntary examination has been
131    initiated who is being evaluated or treated at a hospital for an
132    emergency medical condition specified in s. 395.002 must be
133    examined by a receiving facility within 72 hours. The 72-hour
134    period begins when the patient arrives at the hospital and
135    ceases when the attending physician documents that the patient
136    has an emergency medical condition. If the patient is examined
137    at a hospital providing emergency medical services by a
138    professional qualified to perform an involuntary examination and
139    is found as a result of that examination not to meet the
140    criteria for involuntary outpatient placement pursuant to s.
141    394.466(1) or involuntary inpatient placement pursuant to s.
142    394.467(1), the patient may be offered voluntary placement, if
143    appropriate, or released directly from the hospital providing
144    emergency medical services. The finding by the professional that
145    the patient has been examined and does not meet the criteria for
146    involuntary inpatient placement or involuntary outpatient
147    placement must be entered into the patient's clinical record.
148    Nothing in this paragraph is intended to prevent a hospital
149    providing emergency medical services from appropriately
150    transferring a patient to another hospital prior to
151    stabilization, provided the requirements of s. 395.1041(3)(c)
152    have been met.
153          (i) Within the 72-hour examination period or, if the 72
154    hours ends on a weekend or holiday, no later than the next
155    working day thereafter, one of the following actions must be
156    taken, based on the individual needs of the patient:
157          1. The patient shall be released, unless he or she is
158    charged with a crime, in which case the patient shall be
159    returned to the custody of a law enforcement officer;
160          2. The patient shall be released, subject to the
161    provisions of subparagraph 1., for voluntaryoutpatient
162    treatment;
163          3. The patient, unless he or she is charged with a crime,
164    shall be asked to give express and informed consent to placement
165    as a voluntary patient, and, if such consent is given, the
166    patient shall be admitted as a voluntary patient; or
167          4. A petition for involuntary inpatient placement or a
168    petition for involuntary outpatientplacement shall be filed in
169    the appropriate court by the petitioner delineated in s.
170    394.466(3)(a)facility administratorwhen treatment is deemed
171    necessary; in which case, the least restrictive treatment
172    consistent with the optimum improvement of the patient's
173    condition shall be made available.
174          Section 6. Section 394.466, Florida Statutes, is created
175    to read:
176          394.466 Involuntary outpatient placement.--
177          (1) CRITERIA FOR INVOLUNTARY OUTPATIENT PLACEMENT.--
178          (a) A person may be ordered to involuntary outpatient
179    placement upon a finding of the court that, by clear and
180    convincing evidence:
181          1. The person is 18 years of age or older.
182          2. The person has a mental illness.
183          3. The person is unlikely to survive safely in the
184    community without supervision, based on a clinical
185    determination.
186          4. The person has a history of lack of compliance with
187    treatment for mental illness.
188          5. The person has:
189          a. At least twice within the last 36 months, been admitted
190    for examination or placement in a receiving or treatment
191    facility as defined in s. 394.455 or received mental health
192    services in a forensic or correctional facility. The 36-month
193    period does not include any period during which the person was
194    admitted or incarcerated immediately preceding the filing of the
195    petition and does include acts of noncompliance with the
196    treatment and the current admission for consideration; or
197          b. Engaged in one or more acts of serious violent behavior
198    toward himself or herself or others or engaged in attempts at
199    serious bodily harm to himself or herself or others within the
200    last 36 months. The 36-month period does not include any period
201    in which the person was admitted or incarcerated immediately
202    preceding the filing of the petition and does include acts of
203    violence occurring during the admission or incarceration.
204          6. The person is, as a result of his or her mental
205    illness, unlikely to voluntarily participate in the recommended
206    treatment pursuant to the treatment plan.
207          7. In view of the person’s treatment history and current
208    behavior, the person is in need of involuntary outpatient
209    placement in order to prevent a relapse or deterioration which
210    would be likely to result in serious bodily harm to himself or
211    herself or others, or a substantial harm to his or her well-
212    being as defined in s. 394.463(1).
213          8. It is likely that the person will benefit from
214    involuntary outpatient placement.
215          9. All available less restrictive alternatives which would
216    offer an opportunity for improvement of his or her condition
217    have been judged to be inappropriate.
218          (b) Each required criteria for involuntary outpatient
219    placement must be alleged in the petition and substantiated by
220    hospitalization or arrest records that shall be attached to the
221    petition or a sworn affidavit that shall be attached to the
222    petition. The petition shall consist of a clinical determination
223    by a qualified professional who shall be required to attend the
224    hearing pursuant to subsection (6). The patient shall be allowed
225    an opportunity to present evidence and testimony at the hearing
226    to refute or rebut said allegations.
227          (2) INVOLUNTARY OUTPATIENT PLACEMENT.--
228          (a) A patient may be retained by a receiving facility
229    unless the patient has been stabilized and no longer meets the
230    involuntary examination criteria pursuant to s. 394.463(1), in
231    which case the patient must be placed in outpatient treatment
232    while awaiting the hearing for involuntary outpatient placement
233    upon the recommendation of the administrator of a receiving
234    facility where the patient has been examined and after adherence
235    to the notice and hearing procedures provided in s. 394.4599.
236    The recommendation must be supported by the opinion of a
237    psychiatrist and the second opinion of a clinical psychologist
238    or another psychiatrist, both of whom have personally examined
239    the patient within the preceding 72 hours, that the criteria for
240    involuntary outpatient placement are met. However, in counties
241    of less than 50,000 population, if the administrator certifies
242    that no psychiatrist or clinical psychologist is available to
243    provide the second opinion, such second opinion may be provided
244    by a licensed physician with postgraduate training and
245    experience in diagnosis and treatment of mental and nervous
246    disorders or by a psychiatric nurse. Such recommendation shall
247    be entered on an involuntary outpatient placement certificate,
248    which certificate shall authorize the receiving facility to
249    retain the patient pending transfer to involuntary outpatient
250    placement or completion of a hearing.
251          (b) In cases in which arrangements can be made, a patient
252    may agree to be examined on an outpatient basis for an
253    involuntary outpatient placement certificate. The certificate
254    must be supported by the opinion of a psychiatrist and the
255    second opinion of a clinical psychologist or another
256    psychiatrist, both of whom have personally examined the patient
257    within the preceding 14 calendar days, that the criteria for
258    involuntary outpatient placement are met. However, in counties
259    of less than 50,000 population, if the psychiatrist certifies
260    that no psychiatrist or clinical psychologist is available to
261    provide the second opinion, such second opinion may be provided
262    by a licensed physician with postgraduate training and
263    experience in diagnosis and treatment of mental and nervous
264    disorders or by a psychiatric nurse.
265          (c) If a patient in involuntary inpatient placement meets
266    the criteria for involuntary outpatient placement, the
267    administrator of the treatment facility may, prior to expiration
268    of the period during which the treatment facility is authorized
269    to retain the patient, recommend involuntary outpatient
270    placement. The recommendation must be supported by the opinion
271    of a psychiatrist and the second opinion of a clinical
272    psychologist or another psychiatrist, both of whom have
273    personally examined the patient within the preceding 72 hours,
274    that the criteria for involuntary outpatient placement are met.
275    However, in counties of less than 50,000 population, if the
276    administrator certifies that no psychiatrist or clinical
277    psychologist is available to provide the second opinion, such
278    second opinion may be provided by a licensed physician with
279    postgraduate training and experience in diagnosis and treatment
280    of mental and nervous disorders or by a psychiatric nurse. Such
281    recommendation shall be entered on an involuntary outpatient
282    placement certificate.
283          (3) PETITION FOR INVOLUNTARY OUTPATIENT PLACEMENT.--
284          (a) A petition for involuntary outpatient placement may be
285    filed only when the full range of services that the person needs
286    for mental health treatment and to live and function
287    successfully are available in the patient’s local community. The
288    petitioner must certify in a sworn affidavit attached to the
289    petition the comprehensive array of necessary services, the
290    individual patient’s needs, and the services that are available
291    in the community. A petition may be filed by:
292          1. The administrator of the facility pursuant to paragraph
293    (2)(a);
294          2. One of the examining professionals for persons examined
295    on a voluntary outpatient basis pursuant to paragraph (2)(b).
296    Upon filing, the examining professional shall provide a copy of
297    the petition to the administrator of the receiving facility or
298    designated department representative that will identify the
299    service provider for the involuntary outpatient placement; or
300          3. The administrator of a treatment facility pursuant to
301    paragraph (2)(c). Upon filing, the administrator shall provide a
302    copy of the petition to the administrator of the receiving
303    facility or designated department representative that will
304    identify the service provider for the involuntary outpatient
305    placement.
306          (b) The petition for involuntary outpatient placement
307    shall be filed in the county where the patient is located. Upon
308    filing, the clerk of the court shall provide copies to the
309    department, the patient, the patient's guardian or
310    representative, and the state attorney and public defender of
311    the judicial circuit in which the patient is located. No fee
312    shall be charged for the filing of a petition under this
313    paragraph.
314          (4) APPOINTMENT OF COUNSEL.--Within 1 court working day
315    after the filing of a petition for involuntary outpatient
316    placement, the court shall appoint the public defender to
317    represent the person who is the subject of the petition, unless
318    the person is otherwise represented by counsel. The clerk of the
319    court shall immediately notify the public defender of such
320    appointment. The public defender shall represent the person
321    until the petition is dismissed or the court order expires or
322    the patient is discharged from involuntary outpatient placement.
323    Any attorney representing the patient shall have access to the
324    patient, witnesses, and records relevant to the presentation of
325    the patient's case and shall represent the interests of the
326    patient, regardless of the source of payment to the attorney.
327          (5) CONTINUANCE OF HEARING.--The patient is entitled, with
328    the concurrence of the patient's counsel, to at least one
329    continuance of the hearing. The continuance shall be for a
330    period of up to 4 weeks.
331          (6) HEARING ON INVOLUNTARY OUTPATIENT PLACEMENT.--
332          (a)1. The court shall hold the hearing on involuntary
333    outpatient placement within 5 days after the petition is filed,
334    unless a continuance is granted. The hearing shall be held in
335    the county where the patient is located and shall be as
336    convenient to the patient as may be consistent with orderly
337    procedure and shall be conducted in physical settings not likely
338    to be injurious to the patient's condition. The state attorney
339    for the circuit in which the patient is located shall represent
340    the state, rather than the petitioner, as the real party in
341    interest in the proceeding.
342          2. The court may appoint a master to preside at the
343    hearing. One of the professionals who executed the involuntary
344    outpatient placement certificate shall be a witness. The patient
345    and the patient's guardian or representative shall be informed
346    by the court of the right to an independent expert examination.
347    If the patient cannot afford such an examination, the court
348    shall provide for one. The independent expert's report shall be
349    confidential and not discoverable, unless the expert is to be
350    called as a witness for the patient at the hearing. The court
351    shall allow testimony from individuals, including family
352    members, deemed by the court to be relevant under the law of
353    this state, regarding the person’s prior history, and how that
354    prior history relates to the person’s current condition. The
355    testimony in the hearing must be given under oath and the
356    proceedings must be recorded. The patient may refuse to testify
357    at the hearing.
358          (b)1. If the court concludes that the patient meets the
359    criteria for involuntary outpatient placement pursuant to
360    subsection (1), the court shall issue an order for involuntary
361    outpatient placement. The court order shall be for a period of
362    up to 6 months. The service provider shall discharge a patient
363    any time the patient no longer meets the criteria for
364    involuntary placement.
365          2. The administrator of a receiving facility or designated
366    department representative shall identify the service provider
367    that will have primary responsibility for service provision
368    under the order. The service provider shall prepare a written
369    proposed treatment plan and submit the plan to the court prior
370    to the hearing for the court’s consideration for inclusion in
371    the involuntary outpatient placement order. The treatment plan
372    shall specify the nature and extent of the patient's mental
373    illness. The treatment plan may include provisions for case
374    management, intensive case management, assertive community
375    treatment, or a program for assertive community treatment. The
376    treatment plan may also require that the patient make use of a
377    service provider to supply any of the following categories of
378    services to the individual: medication, periodic urinalysis to
379    determine compliance with treatment, individual or group
380    therapy, day or partial day programming activities, educational
381    and vocational training or activities, alcohol or substance
382    abuse treatment and counseling and periodic tests for the
383    presence of alcohol or illegal drugs for persons with a history
384    of alcohol or substance abuse, supervision of living
385    arrangements, and any other services prescribed to treat the
386    person’s mental illness and to assist the person in living and
387    functioning in the community or to attempt to prevent a relapse
388    or deterioration. The service provider shall certify to the
389    court in the treatment plan that the proposed services are
390    currently available and that the service provider agrees to
391    provide those services. Service providers may select and provide
392    supervision to other individuals not enumerated in this
393    subparagraph to implement specific aspects of the treatment
394    plan, such as medication monitoring. The services in the
395    treatment plan shall be deemed to be clinically appropriate by a
396    physician, clinical psychologist, psychiatric nurse, or clinical
397    social worker who consults with, or is employed or contracted
398    by, the service provider. The court shall not order the
399    department or the service provider to provide services if the
400    program or service is not available in the patient’s local
401    community or there is no space available in the program or
402    service for the patient or if funding is not available for the
403    program or service. A copy of the order shall be sent to the
404    Agency for Health Care Administration. After the placement order
405    is issued, the service provider and the patient can modify
406    provisions of the treatment plan. For any material modification
407    of the provisions of the treatment plan, the service provider
408    shall send notice of the modification to the court. Any material
409    modification of the provisions of the treatment plan that are
410    contested by the patient must be approved by the court.
411          3. When, in the clinical judgment of a physician, the
412    patient has failed or refused to comply with the treatment
413    ordered by the court, efforts were made to solicit compliance,
414    and such patient may meet the criteria for involuntary
415    examination, a person may be brought to a receiving facility
416    pursuant to s. 394.463. If, after examination, the patient does
417    not meet the criteria for involuntary inpatient placement
418    pursuant to s. 394.467, the patient must be discharged from the
419    receiving facility. The service provider must determine whether
420    modifications should be made to the existing treatment plan and
421    attempt to continue to engage the patient in treatment. For any
422    material modification of the provisions of the treatment plan to
423    which the patient or, if appointed, the patient’s guardian
424    advocate does agree, the service provider shall send notice of
425    the modification to the court. Any material modification of the
426    provisions of the treatment plan that are contested by the
427    patient or, if appointed, the patient’s guardian advocate must
428    be approved by the court.
429          (c) If, at any time prior to the conclusion of the initial
430    hearing on involuntary outpatient placement, it appears to the
431    court that the person does not meet the criteria for involuntary
432    outpatient placement under this section but instead meets the
433    criteria for involuntary inpatient placement, the court may
434    order the person admitted for involuntary inpatient placement
435    pursuant to s. 394.467. If the person instead meets the criteria
436    for involuntary assessment, protective custody, or involuntary
437    admission pursuant to s. 397.675, the court may order the person
438    to be admitted for involuntary assessment for a period of 5 days
439    pursuant to s. 397.6811. Thereafter, all proceedings shall be
440    governed by chapter 397.
441          (d) At the hearing on involuntary outpatient placement,
442    the court shall consider testimony and evidence regarding the
443    patient's competence to consent to treatment. If the court finds
444    that the patient is incompetent to consent to treatment, the
445    court shall appoint a guardian advocate as provided in s.
446    394.4598 from a list of qualified and available guardian
447    advocates submitted to the court with the petition. The guardian
448    advocate’s role shall be to monitor the patient’s care to ensure
449    that the patient’s rights are protected. The guardian advocate
450    is immune from liability under this provision. If the patient,
451    the patient’s guardian advocate, and the service provider agree
452    that the guardian advocate is no longer needed because the
453    person is competent, the guardian advocate may be discharged.
454          (e) The administrator of the receiving facility or
455    designated department representative shall provide a copy of the
456    court order and adequate documentation of a patient's mental
457    illness to the service provider for involuntary outpatient
458    placement. Such documentation shall include any advance
459    directives made by the patient, a psychiatric evaluation of the
460    patient, and any evaluations of the patient performed by a
461    clinical psychologist or a clinical social worker.
462          (7) PROCEDURE FOR CONTINUED INVOLUNTARY OUTPATIENT
463    PLACEMENT.--
464          (a) If the person continues to meet the criteria for
465    involuntary outpatient placement, the service provider shall,
466    prior to the expiration of the period during which the treatment
467    is ordered for the person, file in the circuit court a continued
468    involuntary outpatient placement certificate which shall be
469    accompanied by a statement from the person’s physician or
470    clinical psychologist justifying the request, a brief
471    description of the patient's treatment during the time he or she
472    was involuntarily placed, and an individualized plan of
473    continued treatment.
474          (b) Within 1 court working day after the filing of a
475    petition for continued involuntary outpatient placement, the
476    court shall appoint the public defender to represent the person
477    who is the subject of the petition, unless the person is
478    otherwise represented by counsel. The clerk of the court shall
479    immediately notify the public defender of such appointment. The
480    public defender shall represent the person until the petition is
481    dismissed, the court order expires, or the patient is discharged
482    from involuntary outpatient placement. Any attorney representing
483    the patient shall have access to the patient, witnesses, and
484    records relevant to the presentation of the patient's case and
485    shall represent the interests of the patient, regardless of the
486    source of payment to the attorney.
487          (c) Hearings on petitions for continued involuntary
488    outpatient placement shall be before the circuit court. The
489    court may appoint a master to preside at the hearing. The
490    procedures for obtaining an order pursuant to this paragraph
491    shall be in accordance with the provisions of subsection (6),
492    except that the time period included in subparagraph (1)(a)5.
493    shall not apply in determining the appropriateness of additional
494    periods of involuntary outpatient placement.
495          (d) Notice of the hearing shall be provided as set forth
496    in s. 394.4599.
497          (e) The same procedure shall be repeated prior to the
498    expiration of each additional period the patient is placed in
499    treatment.
500          (f) If the patient has been previously found incompetent
501    to consent to treatment, the court shall consider testimony and
502    evidence regarding the patient's competence. If the court finds
503    evidence that the patient has become competent to consent to
504    treatment, the court may order that any guardian advocate
505    previously appointed be discharged.
506          Section 7. Section 394.467, Florida Statutes, is amended
507    to read:
508          394.467 Involuntary inpatientplacement.--
509          (1) CRITERIA.--A person may be involuntarily placed in
510    involuntary inpatient placementfor treatment upon a finding of
511    the court by clear and convincing evidence that:
512          (a) He or she is mentally ill and because of his or her
513    mental illness:
514          1.a. He or she has refused voluntary placement for
515    treatment after sufficient and conscientious explanation and
516    disclosure of the purpose of placement for treatment; or
517          b. He or she is unable to determine for himself or herself
518    whether placement is necessary; and
519          2.a. He or she is manifestly incapable of surviving alone
520    or with the help of willing and responsible family or friends,
521    including available alternative services, and, without
522    treatment, is likely to suffer from neglect or refuse to care
523    for himself or herself, and such neglect or refusal poses a real
524    and present threat of substantial harm to his or her well-being;
525    or
526          b. There is substantial likelihood that in the near future
527    he or she will inflict serious bodily harm on himself or herself
528    or another person, as evidenced by recent behavior causing,
529    attempting, or threatening such harm; and
530          (b) All available less restrictive treatment alternatives
531    which would offer an opportunity for improvement of his or her
532    condition have been judged to be inappropriate.
533          (2) ADMISSION TO A TREATMENT FACILITY.--A patient may be
534    retained by a receiving facility or involuntarily placed in a
535    treatment facility upon the recommendation of the administrator
536    of a receiving facility where the patient has been examined and
537    after adherence to the notice and hearing procedures provided in
538    s. 394.4599. The recommendation must be supported by the opinion
539    of a psychiatrist and the second opinion of a clinical
540    psychologist or another psychiatrist, both of whom have
541    personally examined the patient within the preceding 72 hours,
542    that the criteria for involuntary inpatientplacement are met.
543    However, in counties of less than 50,000 population, if the
544    administrator certifies that no psychiatrist or clinical
545    psychologist is available to provide the second opinion, such
546    second opinion may be provided by a licensed physician with
547    postgraduate training and experience in diagnosis and treatment
548    of mental and nervous disorders or by a psychiatric nurse. Such
549    recommendation shall be entered on an involuntary inpatient
550    placement certificate, which certificate shall authorize the
551    receiving facility to retain the patient pending transfer to a
552    treatment facility or completion of a hearing.
553          (3) PETITION FOR INVOLUNTARY INPATIENTPLACEMENT.--The
554    administrator of the facility shall file a petition for
555    involuntary inpatientplacement in the court in the county where
556    the patient is located. Upon filing, the clerk of the court
557    shall provide copies to the department, the patient, the
558    patient's guardian or representative, and the state attorney and
559    public defender of the judicial circuit in which the patient is
560    located. No fee shall be charged for the filing of a petition
561    under this subsection.
562          (4) APPOINTMENT OF COUNSEL.--Within 1 court working day
563    after the filing of a petition for involuntary inpatient
564    placement, the court shall appoint the public defender to
565    represent the person who is the subject of the petition, unless
566    the person is otherwise represented by counsel. The clerk of the
567    court shall immediately notify the public defender of such
568    appointment. Any attorney representing the patient shall have
569    access to the patient, witnesses, and records relevant to the
570    presentation of the patient's case and shall represent the
571    interests of the patient, regardless of the source of payment to
572    the attorney.
573          (5) CONTINUANCE OF HEARING.--The patient is entitled, with
574    the concurrence of the patient's counsel, to at least one
575    continuance of the hearing. The continuance shall be for a
576    period of up to 4 weeks.
577          (6) HEARING ON INVOLUNTARY INPATIENTPLACEMENT.--
578          (a)1. The court shall hold the hearing on involuntary
579    inpatientplacement within 5 days, unless a continuance is
580    granted. The hearing shall be held in the county where the
581    patient is located and shall be as convenient to the patient as
582    may be consistent with orderly procedure and shall be conducted
583    in physical settings not likely to be injurious to the patient's
584    condition. If the court finds that the patient's attendance at
585    the hearing is not consistent with the best interests of the
586    patient, and the patient's counsel does not object, the court
587    may waive the presence of the patient from all or any portion of
588    the hearing. The state attorney for the circuit in which the
589    patient is located shall represent the state, rather than the
590    petitioning facility administrator, as the real party in
591    interest in the proceeding.
592          2. The court may appoint a master to preside at the
593    hearing. One of the professionals who executed the involuntary
594    inpatientplacement certificate shall be a witness. The patient
595    and the patient's guardian or representative shall be informed
596    by the court of the right to an independent expert examination.
597    If the patient cannot afford such an examination, the court
598    shall provide for one. The independent expert's report shall be
599    confidential and not discoverable, unless the expert is to be
600    called as a witness for the patient at the hearing. The
601    testimony in the hearing must be given under oath, and the
602    proceedings must be recorded. The patient may refuse to testify
603    at the hearing.
604          (b) If the court concludes that the patient meets the
605    criteria for involuntary inpatientplacement, it shall order
606    that the patient be transferred to a treatment facility or, if
607    the patient is at a treatment facility, that the patient be
608    retained there or be treated at any other appropriate receiving
609    or treatment facility, or that the patient receive services from
610    a receiving or treatment facility, on an involuntary basis, for
611    a period of up to 6 months. The order shall specify the nature
612    and extent of the patient's mental illness. The facility shall
613    discharge a patient any time the patient no longer meets the
614    criteria for involuntary inpatientplacement, unless the patient
615    has transferred to voluntary status.
616          (c) If at any time prior to the conclusion of the hearing
617    on involuntary inpatientplacement it appears to the court that
618    the person does not meet the criteria for involuntary inpatient
619    placement under this sectionchapter, but instead meets the
620    criteria for involuntary outpatient placement, the court may
621    order the person evaluated for involuntary outpatient placement
622    pursuant to s. 394.466. The petition and hearing procedures set
623    forth in s. 394.466 shall apply. If the personinstead meets the
624    criteria for involuntary assessment, protective custody, or
625    involuntary admission pursuant to s. 397.675, then the court may
626    order the person to be admitted for involuntary assessment for a
627    period of 5 days pursuant to s. 397.6811. Thereafter, all
628    proceedings shall be governed by chapter 397.
629          (d) At the hearing on involuntary inpatientplacement, the
630    court shall consider testimony and evidence regarding the
631    patient's competence to consent to treatment. If the court finds
632    that the patient is incompetent to consent to treatment, it
633    shall appoint a guardian advocate as provided in s. 394.4598.
634          (e) The administrator of the receiving facility shall
635    provide a copy of the court order and adequate documentation of
636    a patient's mental illness to the administrator of a treatment
637    facility whenever a patient is ordered for involuntary inpatient
638    placement, whether by civil or criminal court. Such
639    documentation shall include any advance directives made by the
640    patient, a psychiatric evaluation of the patient, and any
641    evaluations of the patient performed by a clinical psychologist
642    or a clinical social worker. The administrator of a treatment
643    facility may refuse admission to any patient directed to its
644    facilities on an involuntary basis, whether by civil or criminal
645    court order, who is not accompanied at the same time by adequate
646    orders and documentation.
647          (7) PROCEDURE FOR CONTINUED INVOLUNTARY INPATIENT
648    PLACEMENT.--
649          (a) Hearings on petitions for continued involuntary
650    inpatientplacement shall be administrative hearings and shall
651    be conducted in accordance with the provisions of s. 120.57(1),
652    except that any order entered by the hearing officer shall be
653    final and subject to judicial review in accordance with s.
654    120.68. Orders concerning patients committed after successfully
655    pleading not guilty by reason of insanity shall be governed by
656    the provisions of s. 916.15.
657          (b) If the patient continues to meet the criteria for
658    involuntary inpatientplacement, the administrator shall, prior
659    to the expiration of the period during which the treatment
660    facility is authorized to retain the patient, file a petition
661    requesting authorization for continued involuntary inpatient
662    placement. The request shall be accompanied by a statement from
663    the patient's physician or clinical psychologist justifying the
664    request, a brief description of the patient's treatment during
665    the time he or she was involuntarily placed, and an
666    individualized plan of continued treatment. Notice of the
667    hearing shall be provided as set forth in s. 394.4599. If at the
668    hearing the hearing officer finds that attendance at the hearing
669    is not consistent with the best interests of the patient, the
670    hearing officer may waive the presence of the patient from all
671    or any portion of the hearing, unless the patient, through
672    counsel, objects to the waiver of presence. The testimony in the
673    hearing must be under oath, and the proceedings must be
674    recorded.
675          (c) Unless the patient is otherwise represented or is
676    ineligible, he or she shall be represented at the hearing on the
677    petition for continued involuntary inpatientplacement by the
678    public defender of the circuit in which the facility is located.
679          (d) If at a hearing it is shown that the patient continues
680    to meet the criteria for involuntary inpatientplacement, the
681    administrative law judge shall sign the order for continued
682    involuntary inpatientplacement for a period not to exceed 6
683    months. The same procedure shall be repeated prior to the
684    expiration of each additional period the patient is retained.
685          (e) If continued involuntary inpatientplacement is
686    necessary for a patient admitted while serving a criminal
687    sentence, but whose sentence is about to expire, or for a
688    patient involuntarily placed while a minor but who is about to
689    reach the age of 18, the administrator shall petition the
690    administrative law judge for an order authorizing continued
691    involuntary inpatientplacement.
692          (f) If the patient has been previously found incompetent
693    to consent to treatment, the hearing officer shall consider
694    testimony and evidence regarding the patient's competence. If
695    the hearing officer finds evidence that the patient is now
696    competent to consent to treatment, the hearing officer may issue
697    a recommended order to the court that found the patient
698    incompetent to consent to treatment that the patient's
699    competence be restored and that any guardian advocate previously
700    appointed be discharged.
701          (8) RETURN OF PATIENTS.--When a patient at a treatment
702    facility leaves the facility without authorization, the
703    administrator may authorize a search for the patient and the
704    return of the patient to the facility. The administrator may
705    request the assistance of a law enforcement agency in the search
706    for and return of the patient.
707          Section 8. Involuntary Outpatient Placement Implementation
708    Task Force.--
709          (1) The Involuntary Outpatient Placement Implementation
710    Task Force is established to develop a plan for implementation
711    of the involuntary outpatient placement procedures established
712    in this act. The task force shall include a representative from
713    each of the following entities, to be designated by their
714    respective organizations no later than July 1, 2003: the Florida
715    Sheriffs Association, the Florida Police Chiefs Association, the
716    Florida Public Defender Association, Inc., the Florida
717    Prosecuting Attorneys Association, the Florida Association of
718    Court Clerks, the Florida Association of Counties, the
719    Department of Children and Family Services, the Florida Council
720    for Community Mental Health, and the Agency for Health Care
721    Administration. Additionally, a member of the Senate shall be
722    designated by the President of the Senate, a member of the House
723    of Representatives shall be designated by the Speaker of the
724    House of Representatives, a representative of the Executive
725    Office of the Governor shall be designated by the Governor, and
726    a circuit judge shall be designated by the Chief Justice of the
727    Supreme Court to serve on the task force. The representative for
728    the Florida Sheriffs Association and the circuit judge shall be
729    designated by the Chief Justice of the Florida Supreme Court and
730    shall serve as co-chairs of the task force. The task force
731    should solicit and receive input from interested parties.
732          (2) The task force shall be convened no later than August
733    1, 2003. Staff support for the initial meeting shall be provided
734    by staff of the House Committee on the Future of Florida’s
735    Families and the Senate Committee on Children and Families. The
736    co-chairs shall facilitate the meetings and make appropriate
737    arrangements for staff support of subsequent meetings and
738    preparation of an implementation plan and report. Expenses
739    associated with task force meetings and work products shall be
740    the responsibility of each member’s organization.
741          (3) The task force shall prepare an implementation plan
742    and report that identifies issues and proposed strategies for
743    implementation of court-ordered mental health treatment on an
744    outpatient basis. The task force shall also address issues,
745    including, but not limited to, recommendations for an evaluation
746    process to determine the effectiveness of involuntary outpatient
747    placement and proposed technical amendments to the Florida
748    Statutes to improve implementation, if necessary and
749    appropriate. The implementation plan and report must recommend a
750    process to collect data that reflects the impact of involuntary
751    outpatient placement on the courts, state attorneys, public
752    defenders, clerks of court, law enforcement, jails, and the
753    mental health treatment system. The report must be submitted by
754    December 1, 2003, to the Governor, the President of the Senate,
755    the Speaker of the House of Representatives, and the Chief
756    Justice of the Florida Supreme Court.
757          Section 9. Any additional costs or expenses related to
758    implementation and enforcement of this act by the judiciary of
759    this state shall be a local requirement pursuant to chapter 29,
760    Florida Statutes.
761          Section 10. If any provision of this act or its
762    application to any person or circumstance is held invalid, the
763    invalidity does not affect other provisions or applications of
764    the act which can be given effect without the invalid provision
765    or application, and to this end the provisions of this act are
766    severable.
767         
768    ================= T I T L E A M E N D M E N T =================
769          On page 1, line(s) 8 and 9,
770          remove: all of said lines
771          and insert: of an involuntary examination; amending s.
772    394.455, F.S.; revising a definition; providing additional
773    definitions; amending s. 394.4598, F.S.; revising language
774    with respect to the guardian advocate; authorizing the
775    guardian advocate to consent to administration of
776    medication over objection under certain circumstances;
777    amending s. 394.4615, F.S.; providing for release of
778    certain clinical records to certain persons for certain
779    purposes; amending s. 394.463, F.S.; revising criteria and
780    procedures for involuntary examination; creating s.
781    394.466, F.S.; setting forth criteria for involuntary
782    outpatient placement; providing contents of a petition for
783    involuntary outpatient placement; specifying procedures
784    for involuntary outpatient placement; providing for
785    persons who may file a petition for involuntary outpatient
786    placement; providing for appointment of counsel; providing
787    for continuance of hearings; providing for a hearing on
788    involuntary outpatient placement; setting forth procedures
789    for the hearing; providing for appointment of a master to
790    preside; providing for an independent examination;
791    requiring a court to order involuntary outpatient
792    placement under certain circumstances; requiring a
793    treatment plan; providing for plan modification; providing
794    for a patient to be brought to a receiving facility upon
795    failure or refusal to comply with the treatment plan;
796    providing for involuntary inpatient placement or
797    involuntary assessment; requiring consideration of a
798    patient’s competence to proceed; requiring a list of
799    guardian advocates to be submitted to the court; defining
800    the role of a guardian advocate; providing for discharge
801    of the guardian advocate; requiring certain documentation;
802    allowing a person for whom an involuntary outpatient
803    placement petition has been filed to agree to a voluntary
804    treatment agreement; specifying requirements for
805    agreements; providing for modifications; providing for
806    filing of an affidavit of noncompliance with a voluntary
807    treatment plan; requiring a hearing; requiring dismissal
808    of petitions in certain circumstances; providing
809    procedures for continued involuntary outpatient placement;
810    providing for a continued involuntary outpatient placement
811    certificate; requiring a hearing; requiring appointment of
812    a public defender; requiring hearings; providing for
813    appointment of a special master; amending s. 394.467,
814    F.S.; revising language with respect to involuntary
815    inpatient placement; providing a reference to inpatient
816    and outpatient involuntary placement; providing
817    requirements for placement orders; providing for voluntary
818    treatment agreements; providing a procedure for continued
819    involuntary outpatient placement; establishing the
820    Involuntary Outpatient Placement Implementation Task
821    Force; providing purposes; providing for membership;
822    providing for meetings; requiring the task force to
823    prepare an implementation plan relating to court-ordered
824    mental health outpatient treatment; requiring a report to
825    the Governor, Legislature, and Florida Supreme Court;
826    specifying certain costs or expenses related to
827    implementation and enforcement by the state judiciary as a
828    local requirement; providing for severability; providing
829    an effective date.
830         
831          WHEREAS, untreated mental illness is a difficult issue
832    confronting every Florida community, and
833          WHEREAS, there are Floridians with severe mental illnesses
834    who are prone to relapse, often fail to comply with their
835    treatment plans, and have repeated hospitalizations and criminal
836    justice contacts, who are sometimes referred to as "Baker Act
837    recidivists," and
838          WHEREAS, many states use some form of civil commitment to
839    compel Baker Act recidivists to undergo treatment on an
840    involuntary outpatient basis, and
841          WHEREAS, it is the intent of the Legislature to protect
842    public safety and ensure that Baker Act recidivists receive
843    needed mental health services, while preserving the due process
844    rights of individuals with mental illness, and
845          WHEREAS, implementation and oversight of the involuntary
846    outpatient placement system involves the cooperative efforts and
847    combined resources of the Department of Children and Family
848    Services, the offices of the state attorneys, the offices of the
849    public defenders, the state courts, the clerks of court, and law
850    enforcement, among others, and
851          WHEREAS, the State of Florida is facing numerous
852    unprecedented fiscal challenges, some of which have a direct
853    bearing on involuntary outpatient placement, including revenue
854    shortfalls, the transition to state funding of the judicial
855    branch pursuant to Article V Revision 7, consideration of the
856    proper placement of the Mental Health Program Office, and
857    development of strategies to address the staggering growth in
858    Medicaid spending, and
859          WHEREAS, it is the intent of the Legislature to address
860    this issue in a deliberative, thoughtful process which allows
861    consideration of the difficult fiscal issues presented by a
862    statutory process for involuntary outpatient placement and to
863    appoint a task force to make recommendations on the effectuation
864    of court-ordered outpatient mental health treatment in
865    sufficient time to allow the stakeholders and funding entities
866    to adequately prepare for implementation in fiscal year 2004-
867    2005, NOW, THEREFORE,
868