HB 0463 2004
1	A bill to be entitled
2	An act relating to mental health; amending s. 394.455,
3	F.S.; revising a definition; providing additional
4	definitions of terms used in pt. I of ch. 394, F.S., "The
5	Baker Act"; amending s. 394.4598, F.S.; revising language
6	with respect to the guardian advocate; authorizing the
7	guardian advocate to consent to administration of
8	medication over objection under certain circumstances;
9	amending s. 394.4615, F.S.; providing for release of
10	certain clinical records to certain persons for certain
11	purposes; amending s. 394.463, F.S.; revising criteria and
12	procedures for involuntary examination; creating s.
13	394.4655, F.S.; providing criteria and procedures for
14	involuntary outpatient placement; providing for a
15	voluntary examination for outpatient placement; providing
16	for a petition for involuntary outpatient placement;
17	providing for appointment of counsel; providing for
18	continuance of hearings; providing for a hearing on
19	involuntary outpatient placement; setting forth procedures
20	for the hearing; providing for appointment of a master to
21	preside; providing for an independent examination;
22	requiring a court to order involuntary outpatient
23	placement under certain circumstances; requiring a
24	treatment plan; providing for plan modification; providing
25	for a patient to be brought to a receiving facility upon
26	failure or refusal to comply with the treatment plan;
27	providing for involuntary inpatient placement or
28	involuntary assessment; requiring consideration of a
29	patient's competence to proceed; requiring a list of
30	guardian advocates to be submitted to the court; defining
31	the role of a guardian advocate; providing for discharge
32	of the guardian advocate; requiring certain documentation;
33	allowing a person for whom an involuntary outpatient
34	placement petition has been filed to agree to a voluntary
35	treatment agreement; specifying requirements for
36	agreements; providing for modifications; providing for
37	filing of an affidavit of noncompliance with a voluntary
38	treatment plan; requiring a hearing; requiring dismissal
39	of petitions in certain circumstances; providing
40	procedures for continued involuntary outpatient placement;
41	providing for a continued involuntary outpatient placement
42	certificate; requiring a hearing; requiring appointment of
43	a public defender; requiring hearings; providing for
44	appointment of a special master; amending s. 394.467,
45	F.S.; revising language with respect to involuntary
46	inpatient placement; providing a reference to inpatient
47	and outpatient involuntary placement; providing
48	requirements for placement orders; providing for voluntary
49	treatment agreements; providing a procedure for continued
50	involuntary outpatient placement; amending ss. 394.495,
51	394.496, 394.498, 419.001, and 744.704, F.S.; correcting
52	cross references; authorizing the Department of Children
53	and Family Services to adopt rules; providing
54	severability; providing an effective date.
55
56	Be It Enacted by the Legislature of the State of Florida:
57
58	Section 1. Subsection (3) of section 394.455, Florida
59	Statutes, is amended, existing subsections (16)-(28) are
60	renumbered as subsections (17)-(29), respectively, existing
61	subsections (29) and (30) are renumbered as subsections (31) and
62	(32), respectively, and new subsections (16) and (30) are added
63	to said section, to read:
64	394.455 Definitions.--As used in this part, unless the
65	context clearly requires otherwise, the term:
66	(3) "Clinical record" means all parts of the record
67	required to be maintained and includes all medical records,
68	progress notes, charts, and admission and discharge data, and
69	all other information recorded by a facility which pertains to
70	the patient's hospitalization or andtreatment.
71	(16) "Involuntary placement" means involuntary outpatient
72	treatment pursuant to s. 394.4655 or involuntary inpatient
73	treatment pursuant to s. 394.467.
74	(30) "Service provider" means any public or private
75	receiving facility, an entity under contract with the Department
76	of Children and Family Services to provide mental health
77	services, or a clinical psychologist, clinical social worker,
78	physician, or psychiatric nurse, or a community mental health
79	center or clinic as defined in this part.
80	Section 2. Subsections (1) and (7) of section 394.4598,
81	Florida Statutes, are amended to read:
82	394.4598 Guardian advocate.--
83	(1) The administrator may petition the court for the
84	appointment of a guardian advocate based upon the opinion of a
85	psychiatrist that the patient is incompetent to consent to
86	treatment. If the court finds that a patient is incompetent to
87	consent to treatment and has not been adjudicated incapacitated
88	and a guardian with the authority to consent to mental health
89	treatment appointed, it shall appoint a guardian advocate. The
90	patient has the right to have an attorney represent him or her
91	at the hearing. If the person is indigent, the court shall
92	appoint the office of the public defender to represent him or
93	her at the hearing. The patient has the right to testify, cross-
94	examine witnesses, and present witnesses. The proceeding shall
95	be recorded either electronically or stenographically, and
96	testimony shall be provided under oath. One of the professionals
97	authorized to give an opinion in support of a petition for
98	involuntary placement, as described in s. 394.4655 ors.
99	394.467(2), must testify. A guardian advocate must meet the
100	qualifications of a guardian contained in part IV of chapter
101	744, except that a professional referred to in this part, an
102	employee of the facility providing direct services to the
103	patient under this part, a departmental employee, a facility
104	administrator, or member of the Florida local advocacy council
105	shall not be appointed. A person who is appointed as a guardian
106	advocate must agree to the appointment.
107	(7) The guardian advocate shall be discharged when the
108	patient is discharged from an order for involuntary outpatient
109	placement or involuntary inpatient placement a receiving or
110	treatment facility to the communityor when the patient is
111	transferred from involuntary to voluntary status. The court or a
112	hearing officer shall consider the competence of the patient
113	pursuant to subsection (1) and may consider an involuntarily
114	placed patient's competence to consent to treatment at any
115	hearing. Upon sufficient evidence, the court may restore, or the
116	hearing officer may recommend that the court restore, the
117	patient's competence. A copy of the order restoring competence
118	or the certificate of discharge containing the restoration of
119	competence shall be provided to the patient and the guardian
120	advocate.
121	Section 3. Subsection (3) of section 394.4615, Florida
122	Statutes, is amended to read:
123	394.4615 Clinical records; confidentiality.--
124	(3) Information from the clinical record may be released
125	under the following circumstances when:
126	(a) Whena patient has declared an intention to harm other
127	persons. When such declaration has been made, the administrator
128	may authorize the release of sufficient information to provide
129	adequate warning to the person threatened with harm by the
130	patient.
131	(b) Whenthe administrator of the facility or secretary of
132	the department deems release to a qualified researcher as
133	defined in administrative rule, an aftercare treatment provider,
134	or an employee or agent of the department is necessary for
135	treatment of the patient, maintenance of adequate records,
136	compilation of treatment data, aftercare planning, or evaluation
137	of programs.
138	(c) For the purpose of determining whether a person meets
139	the criteria for involuntary outpatient placement or for
140	preparing the proposed treatment plan pursuant to s. 394.4655,
141	the clinical record may be released to the state attorney, the
142	public defender, or the patient's private legal counsel; to the
143	court; and to the appropriate mental health professionals,
144	including the service provider identified in s. 394.4655(6)(b)2.
145	Section 4. Subsection (1) and paragraphs (e), (g), and (i)
146	of subsection (2) of section 394.463, Florida Statutes, are
147	amended to read:
148	394.463 Involuntary examination.--
149	(1) CRITERIA.--A person may be taken to a receiving
150	facility for involuntary examination if there is reason to
151	believe that the person has a mental illness he or she is
152	mentally illand because of his or her mental illness:
153	(a)1.The person has refused voluntary examination after
154	conscientious explanation and disclosure of the purpose of the
155	examination; or
156	(b)2.The person is unable to determine for himself or
157	herself whether examination is necessary; and
158	(c)(b) Based upon the person's current reported or
159	observed behavior, considering any mental health history, there
160	is a substantial likelihood that without care or treatment:
161	1. Without care or treatment, The person will is likely to
162	suffer from neglect or refuse to care for himself or herself;
163	such neglect or refusal will pose posesa real and present
164	threat of substantial harm to his or her well-being; and it is
165	not apparent that such harm may be avoided through the help of
166	willing family members or friends or the provision of other
167	services; or
168	2. There is a substantial likelihood that without care or
169	treatmentThe person will cause serious bodily harm to himself
170	or herself or others in the near future, as evidenced by recent
171	behavior.
172	(2) INVOLUNTARY EXAMINATION.--
173	(e) The Agency for Health Care Administration shall
174	receive and maintain the copies of ex parte orders, involuntary
175	outpatient placement orders issued pursuant to s.
176	394.4655, involuntary inpatient orders issued pursuant to s.
177	394.467,professional certificates, and law enforcement
178	officers' reports. These documents shall be considered part of
179	the clinical record, governed by the provisions of s. 394.4615.
180	The agency shall prepare annual reports analyzing the data
181	obtained from these documents, without information identifying
182	patients, and shall provide copies of reports to the department,
183	the President of the Senate, the Speaker of the House of
184	Representatives, and the minority leaders of the Senate and the
185	House of Representatives.
186	(g) A person for whom an involuntary examination has been
187	initiated who is being evaluated or treated at a hospital for an
188	emergency medical condition specified in s. 395.002 must be
189	examined by a receiving facility within 72 hours. The 72-hour
190	period begins when the patient arrives at the hospital and
191	ceases when the attending physician documents that the patient
192	has an emergency medical condition. If the patient is examined
193	at a hospital providing emergency medical services by a
194	professional qualified to perform an involuntary examination and
195	is found as a result of that examination not to meet the
196	criteria for involuntary outpatient placement pursuant to s.
197	394.4655(1) or involuntary inpatient placement pursuant to s.
198	394.467(1), the patient may be offered voluntary placement, if
199	appropriate, or released directly from the hospital providing
200	emergency medical services. The finding by the professional that
201	the patient has been examined and does not meet the criteria for
202	involuntary inpatient or involuntary outpatientplacement must
203	be entered into the patient's clinical record. Nothing in this
204	paragraph is intended to prevent a hospital providing emergency
205	medical services from appropriately transferring a patient to
206	another hospital prior to stabilization, provided the
207	requirements of s. 395.1041(3)(c) have been met.
208	(i) Within the 72-hour examination period or, if the 72
209	hours ends on a weekend or holiday, no later than the next
210	working day thereafter, one of the following actions must be
211	taken, based on the individual needs of the patient:
212	1. The patient shall be released, unless he or she is
213	charged with a crime, in which case the patient shall be
214	returned to the custody of a law enforcement officer;
215	2. The patient shall be released, subject to the
216	provisions of subparagraph 1., for voluntaryoutpatient
217	treatment;
218	3. The patient, unless he or she is charged with a crime,
219	shall be asked to give express and informed consent to placement
220	as a voluntary patient, and, if such consent is given, the
221	patient shall be admitted as a voluntary patient; or
222	4. A petition for involuntary placement shall be filed in
223	the circuit appropriate court by the facility administratorwhen
224	treatment is deemed necessary,;in which case, the least
225	restrictive treatment consistent with the optimum improvement of
226	the patient's condition shall be made available. A petition for
227	involuntary outpatient placement shall be filed by one of the
228	petitioners delineated in s. 394.4655(3)(a). A petition for
229	involuntary inpatient placement shall be filed by the facility
230	administrator.
231	Section 5. Section 394.4655, Florida Statutes, is created
232	to read:
233	394.4655 Involuntary outpatient placement.--
234	(1) CRITERIA FOR INVOLUNTARY OUTPATIENT PLACEMENT.--A
235	person may be ordered to involuntary outpatient placement upon a
236	finding of the court that, by clear and convincing evidence:
237	(a) The person is 18 years of age or older.
238	(b) The person has a mental illness.
239	(c) The person is unlikely to survive safely in the
240	community without supervision, based on a clinical
241	determination.
242	(d) The person has a history of lack of compliance with
243	treatment for mental illness.
244	(e) The person has:
245	1. At least twice within the preceding 36 months been
246	admitted for examination or placement in a receiving or
247	treatment facility as defined in s. 394.455 or received mental
248	health services in a forensic or correctional facility. The 36-
249	month period does not include any period during which the person
250	was admitted or incarcerated; or
251	2. Engaged in one or more acts of serious violent behavior
252	toward himself or herself or others or engaged in attempts at
253	serious bodily harm to himself or herself or others within the
254	preceding 36 months.
255	(f) The person is, as a result of his or her mental
256	illness, unlikely to voluntarily participate in the recommended
257	treatment pursuant to the treatment plan.
258	(g) In view of the person's treatment history and current
259	behavior, the person is in need of involuntary outpatient
260	placement in order to prevent a relapse or deterioration which
261	would be likely to result in meeting the involuntary examination
262	criteria set forth in s. 394.463(1).
263	(h) It is likely that the person will benefit from
264	involuntary outpatient placement.
265	(i) All available less restrictive alternatives that would
266	offer an opportunity for improvement of his or her condition
267	have been judged to be inappropriate.
268	(2) INVOLUNTARY OUTPATIENT PLACEMENT.--
269	(a) From a receiving facility.--A patient may be retained
270	by a receiving facility upon the recommendation of the
271	administrator of a receiving facility where the patient has been
272	examined and after adherence to the notice and hearing
273	procedures provided in s. 394.4599. The recommendation must be
274	supported by the opinion of a psychiatrist and the second
275	opinion of a clinical psychologist or another psychiatrist, both
276	of whom have personally examined the patient within the
277	preceding 72 hours, that the criteria for involuntary outpatient
278	placement are met. However, in a county having a population of
279	less than 50,000, if the administrator certifies that no
280	psychiatrist or clinical psychologist is available to provide
281	the second opinion, such second opinion may be provided by a
282	licensed physician who has postgraduate training and experience
283	in diagnosis and treatment of mental and nervous disorders or by
284	a psychiatric nurse. Such recommendation shall be entered on an
285	involuntary outpatient placement certificate, which certificate
286	shall authorize the receiving facility to retain the patient
287	pending transfer to involuntary outpatient placement or
288	completion of a hearing. If the patient has been stabilized and
289	no longer meets the criteria for involuntary examination
290	pursuant to s. 394.463(1), the patient must be released from the
291	receiving facility while awaiting the hearing for involuntary
292	outpatient placement.
293	(b) Voluntary examination for outpatient placement.--A
294	patient may choose to be examined on an outpatient basis for an
295	involuntary outpatient placement certificate if such an
296	arrangement can be made. The certificate must be supported by
297	the opinion of a psychiatrist and the second opinion of a
298	clinical psychologist or another psychiatrist, both of whom have
299	personally examined the patient within the preceding 14 calendar
300	days, that the criteria for involuntary outpatient placement are
301	met. However, in a county having a population of less than
302	50,000, if the psychiatrist certifies that no psychiatrist or
303	clinical psychologist is available to provide the second
304	opinion, the second opinion may be provided by a licensed
305	physician who has postgraduate training and experience in
306	diagnosis and treatment of mental and nervous disorders or by a
307	psychiatric nurse.
308	(c) From a treatment facility.--If a patient in
309	involuntary inpatient placement meets the criteria for
310	involuntary outpatient placement, the administrator of the
311	treatment facility may, prior to expiration of the period during
312	which the treatment facility is authorized to retain the
313	patient, recommend involuntary outpatient placement. The
314	recommendation must be supported by the opinion of a
315	psychiatrist and the second opinion of a clinical psychologist
316	or another psychiatrist, both of whom have personally examined
317	the patient within the preceding 72 hours, that the criteria for
318	involuntary outpatient placement are met. However, in a county
319	having a population of less than 50,000, if the administrator
320	certifies that no psychiatrist or clinical psychologist is
321	available to provide the second opinion, such second opinion may
322	be provided by a licensed physician with postgraduate training
323	and experience in diagnosis and treatment of mental and nervous
324	disorders or by a psychiatric nurse. Such recommendation shall
325	be entered on an involuntary outpatient placement certificate.
326	(3) PETITION FOR INVOLUNTARY OUTPATIENT PLACEMENT.--
327	(a) A petition for involuntary outpatient placement may be
328	filed by:
329	1. The administrator of the facility pursuant to paragraph
330	(2)(a);
331	2. One of the examining professionals for persons examined
332	on a voluntary outpatient basis pursuant to paragraph (2)(b).
333	Upon filing the petition, the examining professional shall
334	provide a copy of the petition to the administrator of the
335	receiving facility or designated department representative that
336	will identify the service provider for the involuntary
337	outpatient placement; or
338	3. The administrator of a treatment facility pursuant to
339	paragraph (2)(c). Upon filing the petition, the administrator
340	shall provide a copy of the petition to the administrator of the
341	receiving facility or designated department representative that
342	will identify the service provider for the involuntary
343	outpatient placement.
344	(b) Each required criterion for involuntary outpatient
345	placement must be alleged and substantiated in the petition for
346	involuntary outpatient placement. A copy of the certificate
347	recommending involuntary outpatient placement completed by a
348	qualified professional specified in subsection (2) shall be
349	attached to the petition.
350	(c) The petition for involuntary outpatient placement
351	shall be filed in the county in which the patient is located.
352	When the petition has been filed, the clerk of the court shall
353	provide copies to the department, the patient, the patient's
354	guardian or representative, and the state attorney and public
355	defender of the judicial circuit in which the patient is
356	located. A fee may not be charged for the filing of a petition
357	under this subsection.
358	(4) APPOINTMENT OF COUNSEL.--Within 1 court working day
359	after the filing of a petition for involuntary outpatient
360	placement, the court shall appoint the public defender to
361	represent the person who is the subject of the petition, unless
362	the person is otherwise represented by counsel. The clerk of the
363	court shall immediately notify the public defender of such
364	appointment. The public defender shall represent the person
365	until the petition is dismissed, the court order expires, or the
366	patient is discharged from involuntary outpatient placement. Any
367	attorney who represents the patient shall have access to the
368	patient, witnesses, and records relevant to the presentation of
369	the patient's case and shall represent the interests of the
370	patient, regardless of the source of payment to the attorney.
371	(5) CONTINUANCE OF HEARING.--The patient is entitled, with
372	the concurrence of the patient's counsel, to at least one
373	continuance of the hearing. The continuance shall be for a
374	period of up to 4 weeks.
375	(6) HEARING ON INVOLUNTARY OUTPATIENT PLACEMENT.--
376	(a)1. The court shall hold the hearing on involuntary
377	outpatient placement within 5 days after the petition is filed,
378	unless a continuance is granted. The hearing shall be held in
379	the county in which the patient is located, shall be as
380	convenient to the patient as is consistent with orderly
381	procedure, and shall be conducted in physical settings not
382	likely to be injurious to the patient's condition. If the court
383	finds that the patient's attendance at the hearing is not
384	consistent with the best interests of the patient and the
385	patient's counsel does not object, the court may waive the
386	presence of the patient from all or any portion of the hearing.
387	The state attorney for the circuit in which the patient is
388	located shall represent the state, rather than the petitioner,
389	as the real party in interest in the proceeding.
390	2. The court may appoint a master to preside at the
391	hearing. One of the professionals who executed the involuntary
392	outpatient placement certificate shall be a witness. The patient
393	and the patient's guardian or representative shall be informed
394	by the court of the right to an independent expert examination.
395	If the patient cannot afford such an examination, the court
396	shall provide for one. The independent expert's report shall be
397	confidential and not discoverable, unless the expert is to be
398	called as a witness for the patient at the hearing. The court
399	shall allow testimony from individuals, including family
400	members, deemed by the court to be relevant under state law,
401	regarding the person's prior history and how that prior history
402	relates to the person's current condition. The testimony in the
403	hearing must be given under oath and the proceedings must be
404	recorded. The patient may refuse to testify at the hearing.
405	(b)1. If the court concludes that the patient meets the
406	criteria for involuntary outpatient placement pursuant to
407	subsection (1), the court shall issue an order for involuntary
408	outpatient placement. The court order shall be for a period of
409	up to 6 months. The service provider shall discharge a patient
410	if there is a clinical determination that the patient no longer
411	meets the criteria for involuntary placement.
412	2. The administrator of a receiving facility or designated
413	department representative shall identify the service provider
414	that will have primary responsibility for service provision
415	under the order. The service provider shall prepare a written
416	proposed treatment plan and submit the plan to the court prior
417	to the hearing for the court's consideration for inclusion in
418	the involuntary outpatient placement order. The service provider
419	shall also provide a copy of the proposed treatment plan to the
420	petitioner. The treatment plan must specify the nature and
421	extent of the patient's mental illness. The treatment plan may
422	include provisions for case management, intensive case
423	management, or assertive community treatment or a program for
424	assertive community treatment. The treatment plan may also
425	require that the patient make use of a service provider to
426	supply any of the following categories of services to the
427	individual: medication, periodic urinalysis to determine
428	compliance with treatment, individual or group therapy, day or
429	partial-day programming activities, educational and vocational
430	training or activities, alcohol or substance abuse treatment and
431	counseling and periodic tests for the presence of alcohol or
432	illegal drugs for persons with a history of alcohol or substance
433	abuse, supervision of living arrangements, and any other
434	services prescribed to treat the person's mental illness and to
435	assist the person in living and functioning in the community or
436	to attempt to prevent a relapse or deterioration. Service
437	providers may select and provide supervision to other
438	individuals, not enumerated in this subparagraph, to implement
439	specific aspects of the treatment plan, such as medication
440	monitoring. The services in the treatment plan shall be deemed
441	to be clinically appropriate by a physician, clinical
442	psychologist, psychiatric nurse, or clinical social worker who
443	consults with, or is employed or contracted by, the service
444	provider. The service provider must certify to the court in the
445	proposed treatment plan whether sufficient services for
446	improvement and stabilization are currently available and
447	whether the service provider agrees to provide those services.
448	If the service provider certifies that the services in the
449	proposed treatment plan are not available, then the petitioner
450	shall withdraw the petition. The court may not order the
451	department or the service provider to provide services if the
452	program or service is not available in the patient's local
453	community, there is no space available in the program or service
454	for the patient, or funding is not available for the program or
455	service. A copy of the order shall be sent to the Agency for
456	Health Care Administration. After the placement order is issued,
457	the service provider and the patient may modify provisions of
458	the treatment plan. For any material modification of the
459	treatment plan to which the patient or the patient's guardian
460	advocate, if appointed, does agree, the service provider shall
461	send notice of the modification to the court. Any material
462	modification of the treatment plan that is contested by the
463	patient must be approved by the court.
464	3. If, in the clinical judgment of a physician, the
465	patient has failed or refused to comply with the treatment
466	ordered by the court, efforts were made to solicit compliance,
467	and the patient may meet the criteria for involuntary
468	examination, a person may be brought to a receiving facility
469	pursuant to s. 394.463. If, after examination, the patient does
470	not meet the criteria for involuntary inpatient placement
471	pursuant to s. 394.467, the patient must be discharged from the
472	receiving facility. The service provider must determine whether
473	modifications should be made to the existing treatment plan and
474	attempt to continue to engage the patient in treatment. For any
475	material modification of the treatment plan to which the patient
476	or the patient's guardian advocate, if appointed, does agree,
477	the service provider shall send notice of the modification to
478	the court. Any material modification of the treatment plan that
479	is contested by the patient or the patient's guardian advocate,
480	if appointed, must be approved by the court.
481	(c) If, at any time before the conclusion of the initial
482	hearing on involuntary outpatient placement, it appears to the
483	court that the person does not meet the criteria for involuntary
484	outpatient placement under this section but instead meets the
485	criteria for involuntary inpatient placement, the court may
486	order the person admitted for involuntary inpatient placement
487	pursuant to s. 394.467. If the person instead meets the criteria
488	for involuntary assessment, protective custody, or involuntary
489	admission pursuant to s. 397.675, the court may order the person
490	to be admitted for involuntary assessment for a period of 5 days
491	pursuant to s. 397.6811. Thereafter, all proceedings shall be
492	governed by chapter 397.
493	(d) At the hearing on involuntary outpatient placement,
494	the court shall consider testimony and evidence regarding the
495	patient's competence to consent to treatment. If the court finds
496	that the patient is incompetent to consent to treatment, the
497	court shall appoint a guardian advocate as provided in s.
498	394.4598. The guardian advocate shall be appointed or discharged
499	in accordance with s. 394.4598.
500	(e) The administrator of the receiving facility or the
501	designated department representative shall provide a copy of the
502	court order and adequate documentation of a patient's mental
503	illness to the service provider for involuntary outpatient
504	placement. Such documentation must include any advance
505	directives made by the patient, a psychiatric evaluation of the
506	patient, and any evaluations of the patient performed by a
507	clinical psychologist or a clinical social worker.
508	(7) PROCEDURE FOR CONTINUED INVOLUNTARY OUTPATIENT
509	PLACEMENT.--
510	(a) If the person continues to meet the criteria for
511	involuntary outpatient placement, the service provider shall,
512	prior to the expiration of the period during which the treatment
513	is ordered for the person, file in the circuit court a continued
514	involuntary outpatient placement certificate which shall be
515	accompanied by a statement from the person's physician or
516	clinical psychologist justifying the request, a brief
517	description of the patient's treatment during the time he or she
518	was involuntarily placed, and an individualized plan of
519	continued treatment.
520	(b) Within 1 court working day after the filing of a
521	petition for continued involuntary outpatient placement, the
522	court shall appoint the public defender to represent the person
523	who is the subject of the petition, unless the person is
524	otherwise represented by counsel. The clerk of the court shall
525	immediately notify the public defender of such appointment. The
526	public defender shall represent the person until the petition is
527	dismissed, the court order expires, or the patient is discharged
528	from involuntary outpatient placement. Any attorney representing
529	the patient shall have access to the patient, witnesses, and
530	records relevant to the presentation of the patient's case and
531	shall represent the interests of the patient, regardless of the
532	source of payment to the attorney.
533	(c) Hearings on petitions for continued involuntary
534	outpatient placement shall be before the circuit court. The
535	court may appoint a master to preside at the hearing. The
536	procedures for obtaining an order pursuant to this paragraph
537	shall be in accordance with the provisions of subsection (6),
538	except that the time period included in paragraph (1)(e) is not
539	applicable in determining the appropriateness of additional
540	periods of involuntary outpatient placement.
541	(d) Notice of the hearing shall be provided as set forth
542	in s. 394.4599.
543	(e) The same procedure shall be repeated prior to the
544	expiration of each additional period the patient is placed in
545	treatment.
546	(f) If the patient has been previously found incompetent
547	to consent to treatment, the court shall consider testimony and
548	evidence regarding the patient's competence. Section 394.4598
549	governs the discharge of the guardian advocate if the patient's
550	competency to consent to treatment is restored.
551	Section 6. Section 394.467, Florida Statutes, is amended
552	to read:
553	394.467 Involuntary inpatientplacement.--
554	(1) CRITERIA.--A person may be involuntarily placed in
555	involuntary inpatient placementfor treatment upon a finding of
556	the court by clear and convincing evidence that:
557	(a) He or she is mentally ill and because of his or her
558	mental illness:
559	1.a. He or she has refused voluntary placement for
560	treatment after sufficient and conscientious explanation and
561	disclosure of the purpose of placement for treatment; or
562	b. He or she is unable to determine for himself or herself
563	whether placement is necessary; and
564	2.a. He or she is manifestly incapable of surviving alone
565	or with the help of willing and responsible family or friends,
566	including available alternative services, and, without
567	treatment, is likely to suffer from neglect or refuse to care
568	for himself or herself, and such neglect or refusal poses a real
569	and present threat of substantial harm to his or her well-being;
570	or
571	b. There is substantial likelihood that in the near future
572	he or she will inflict serious bodily harm on himself or herself
573	or another person, as evidenced by recent behavior causing,
574	attempting, or threatening such harm; and
575	(b) All available less restrictive treatment alternatives
576	which would offer an opportunity for improvement of his or her
577	condition have been judged to be inappropriate.
578	(2) ADMISSION TO A TREATMENT FACILITY.--A patient may be
579	retained by a receiving facility or involuntarily placed in a
580	treatment facility upon the recommendation of the administrator
581	of a receiving facility where the patient has been examined and
582	after adherence to the notice and hearing procedures provided in
583	s. 394.4599. The recommendation must be supported by the opinion
584	of a psychiatrist and the second opinion of a clinical
585	psychologist or another psychiatrist, both of whom have
586	personally examined the patient within the preceding 72 hours,
587	that the criteria for involuntary inpatientplacement are met.
588	However, in counties of less than 50,000 population, if the
589	administrator certifies that no psychiatrist or clinical
590	psychologist is available to provide the second opinion, such
591	second opinion may be provided by a licensed physician with
592	postgraduate training and experience in diagnosis and treatment
593	of mental and nervous disorders or by a psychiatric nurse. Such
594	recommendation shall be entered on an involuntary inpatient
595	placement certificate, which certificate shall authorize the
596	receiving facility to retain the patient pending transfer to a
597	treatment facility or completion of a hearing.
598	(3) PETITION FOR INVOLUNTARY INPATIENTPLACEMENT.--The
599	administrator of the facility shall file a petition for
600	involuntary inpatientplacement in the court in the county where
601	the patient is located. Upon filing, the clerk of the court
602	shall provide copies to the department, the patient, the
603	patient's guardian or representative, and the state attorney and
604	public defender of the judicial circuit in which the patient is
605	located. No fee shall be charged for the filing of a petition
606	under this subsection.
607	(4) APPOINTMENT OF COUNSEL.--Within 1 court working day
608	after the filing of a petition for involuntary inpatient
609	placement, the court shall appoint the public defender to
610	represent the person who is the subject of the petition, unless
611	the person is otherwise represented by counsel. The clerk of the
612	court shall immediately notify the public defender of such
613	appointment. Any attorney representing the patient shall have
614	access to the patient, witnesses, and records relevant to the
615	presentation of the patient's case and shall represent the
616	interests of the patient, regardless of the source of payment to
617	the attorney.
618	(5) CONTINUANCE OF HEARING.--The patient is entitled, with
619	the concurrence of the patient's counsel, to at least one
620	continuance of the hearing. The continuance shall be for a
621	period of up to 4 weeks.
622	(6) HEARING ON INVOLUNTARY INPATIENTPLACEMENT.--
623	(a)1. The court shall hold the hearing on involuntary
624	inpatientplacement within 5 days, unless a continuance is
625	granted. The hearing shall be held in the county where the
626	patient is located and shall be as convenient to the patient as
627	may be consistent with orderly procedure and shall be conducted
628	in physical settings not likely to be injurious to the patient's
629	condition. If the court finds that the patient's attendance at
630	the hearing is not consistent with the best interests of the
631	patient, and the patient's counsel does not object, the court
632	may waive the presence of the patient from all or any portion of
633	the hearing. The state attorney for the circuit in which the
634	patient is located shall represent the state, rather than the
635	petitioning facility administrator, as the real party in
636	interest in the proceeding.
637	2. The court may appoint a master to preside at the
638	hearing. One of the professionals who executed the involuntary
639	inpatientplacement certificate shall be a witness. The patient
640	and the patient's guardian or representative shall be informed
641	by the court of the right to an independent expert examination.
642	If the patient cannot afford such an examination, the court
643	shall provide for one. The independent expert's report shall be
644	confidential and not discoverable, unless the expert is to be
645	called as a witness for the patient at the hearing. The
646	testimony in the hearing must be given under oath, and the
647	proceedings must be recorded. The patient may refuse to testify
648	at the hearing.
649	(b) If the court concludes that the patient meets the
650	criteria for involuntary inpatientplacement, it shall order
651	that the patient be transferred to a treatment facility or, if
652	the patient is at a treatment facility, that the patient be
653	retained there or be treated at any other appropriate receiving
654	or treatment facility, or that the patient receive services from
655	a receiving or treatment facility, on an involuntary basis, for
656	a period of up to 6 months. The order shall specify the nature
657	and extent of the patient's mental illness. The facility shall
658	discharge a patient any time the patient no longer meets the
659	criteria for involuntary inpatientplacement, unless the patient
660	has transferred to voluntary status.
661	(c) If at any time prior to the conclusion of the hearing
662	on involuntary inpatientplacement it appears to the court that
663	the person does not meet the criteria for involuntary inpatient
664	placement under this section chapter, but instead meets the
665	criteria for involuntary outpatient placement, the court may
666	order the person evaluated for involuntary outpatient placement
667	pursuant to s. 394.4655. The petition and hearing procedures set
668	forth in s. 394.4655 shall apply. If the person instead meets
669	the criteria for involuntaryassessment, protective custody, or
670	involuntary admission pursuant to s. 397.675, then the court may
671	order the person to be admitted for involuntary assessment for a
672	period of 5 days pursuant to s. 397.6811. Thereafter, all
673	proceedings shall be governed by chapter 397.
674	(d) At the hearing on involuntary inpatientplacement, the
675	court shall consider testimony and evidence regarding the
676	patient's competence to consent to treatment. If the court finds
677	that the patient is incompetent to consent to treatment, it
678	shall appoint a guardian advocate as provided in s. 394.4598.
679	(e) The administrator of the receiving facility shall
680	provide a copy of the court order and adequate documentation of
681	a patient's mental illness to the administrator of a treatment
682	facility whenever a patient is ordered for involuntary inpatient
683	placement, whether by civil or criminal court. Such
684	documentation shall include any advance directives made by the
685	patient, a psychiatric evaluation of the patient, and any
686	evaluations of the patient performed by a clinical psychologist
687	or a clinical social worker. The administrator of a treatment
688	facility may refuse admission to any patient directed to its
689	facilities on an involuntary basis, whether by civil or criminal
690	court order, who is not accompanied at the same time by adequate
691	orders and documentation.
692	(7) PROCEDURE FOR CONTINUED INVOLUNTARY INPATIENT
693	PLACEMENT.--
694	(a) Hearings on petitions for continued involuntary
695	inpatientplacement shall be administrative hearings and shall
696	be conducted in accordance with the provisions of s. 120.57(1),
697	except that any order entered by the hearing officer shall be
698	final and subject to judicial review in accordance with s.
699	120.68. Orders concerning patients committed after successfully
700	pleading not guilty by reason of insanity shall be governed by
701	the provisions of s. 916.15.
702	(b) If the patient continues to meet the criteria for
703	involuntary inpatientplacement, the administrator shall, prior
704	to the expiration of the period during which the treatment
705	facility is authorized to retain the patient, file a petition
706	requesting authorization for continued involuntary inpatient
707	placement. The request shall be accompanied by a statement from
708	the patient's physician or clinical psychologist justifying the
709	request, a brief description of the patient's treatment during
710	the time he or she was involuntarily placed, and an
711	individualized plan of continued treatment. Notice of the
712	hearing shall be provided as set forth in s. 394.4599. If at the
713	hearing the hearing officer finds that attendance at the hearing
714	is not consistent with the best interests of the patient, the
715	hearing officer may waive the presence of the patient from all
716	or any portion of the hearing, unless the patient, through
717	counsel, objects to the waiver of presence. The testimony in the
718	hearing must be under oath, and the proceedings must be
719	recorded.
720	(c) Unless the patient is otherwise represented or is
721	ineligible, he or she shall be represented at the hearing on the
722	petition for continued involuntary inpatientplacement by the
723	public defender of the circuit in which the facility is located.
724	(d) If at a hearing it is shown that the patient continues
725	to meet the criteria for involuntary inpatientplacement, the
726	administrative law judge shall sign the order for continued
727	involuntary inpatientplacement for a period not to exceed 6
728	months. The same procedure shall be repeated prior to the
729	expiration of each additional period the patient is retained.
730	(e) If continued involuntary placement is necessary for a
731	patient admitted while serving a criminal sentence, but whose
732	sentence is about to expire, or for a patient involuntarily
733	placed while a minor but who is about to reach the age of 18,
734	the administrator shall petition the administrative law judge
735	for an order authorizing continued involuntary inpatient
736	placement.
737	(f) If the patient has been previously found incompetent
738	to consent to treatment, the hearing officer shall consider
739	testimony and evidence regarding the patient's competence. If
740	the hearing officer finds evidence that the patient is now
741	competent to consent to treatment, the hearing officer may issue
742	a recommended order to the court that found the patient
743	incompetent to consent to treatment that the patient's
744	competence be restored and that any guardian advocate previously
745	appointed be discharged.
746	(8) RETURN OF PATIENTS.--When a patient at a treatment
747	facility leaves the facility without authorization, the
748	administrator may authorize a search for the patient and the
749	return of the patient to the facility. The administrator may
750	request the assistance of a law enforcement agency in the search
751	for and return of the patient.
752	Section 7. Paragraphs (a) and (c) of subsection (3) of
753	section 394.495, Florida Statutes, are amended to read:
754	394.495 Child and adolescent mental health system of care;
755	programs and services.--
756	(3) Assessments must be performed by:
757	(a) A professional as defined in s. 394.455(2), (4),
758	(22)(21), (24)(23), or (25)(24);
759	(c) A person who is under the direct supervision of a
760	professional as defined in s. 394.455(2), (4), (22)(21),
761	(24)(23), or (25)(24)or a professional licensed under chapter
762	491.
763
764	The department shall adopt by rule statewide standards for
765	mental health assessments, which must be based on current
766	relevant professional and accreditation standards.
767	Section 8. Subsection (6) of section 394.496, Florida
768	Statutes, is amended to read:
769	394.496 Service planning.--
770	(6) A professional as defined in s. 394.455(2), (4),
771	(22)(21), (24)(23), or (25)(24)or a professional licensed under
772	chapter 491 must be included among those persons developing the
773	services plan.
774	Section 9. Paragraphs (a) and (c) of subsection (4) of
775	section 394.498, Florida Statutes, are amended to read:
776	394.498 Child and Adolescent Interagency System of Care
777	Demonstration Models.--
778	(4) ESSENTIAL ELEMENTS.--
779	(a) In order to be approved as a Child and Adolescent
780	Interagency System of Care Demonstration Model, the applicant
781	must demonstrate its capacity to perform the following
782	functions:
783	1. Form a consortium of purchasers, which includes at
784	least three of the following agencies:
785	a. The Mental Health Program and Family Safety and
786	Preservation Program of the Department of Children and Family
787	Services.
788	b. The Medicaid program of the Agency for Health Care
789	Administration.
790	c. The local school district.
791	d. The Department of Juvenile Justice.
792
793	Each agency that participates in the consortium shall enter into
794	a written interagency agreement that defines each agency's
795	responsibilities.
796	2. Establish an oversight body that is responsible for
797	directing the demonstration model. The oversight body must
798	include representatives from the state agencies that comprise
799	the consortium of purchasers under subparagraph 1., as well as
800	local governmental entities, a juvenile court judge, parents,
801	and other community entities. The responsibilities of the
802	oversight body must be specified in writing.
803	3. Select a target population of children and adolescents,
804	regardless of whether the child or adolescent is eligible or
805	ineligible for Medicaid, based on the following parameters:
806	a. The child or adolescent has a serious emotional
807	disturbance or mental illness, as defined in s. 394.492(6),
808	based on an assessment conducted by a licensed practitioner
809	defined in s. 394.455(2), (4), (22)(21), (24)(23), or (25)(24)
810	or by a professional licensed under chapter 491;
811	b. The total service costs per child or adolescent have
812	exceeded $3,000 per month;
813	c. The child or adolescent has had multiple out-of-home
814	placements;
815	d. The existing array of services does not effectively
816	meet the needs of the child or adolescent;
817	e. The case of the child or adolescent has been staffed by
818	a district collaborative planning team and satisfactory results
819	have not been achieved through existing case services plans; and
820	f. The parent or legal guardian of the child or adolescent
821	consents to participating in the demonstration model.
822	4. Select a geographic site for the demonstration model. A
823	demonstration model may be comprised of one or more counties and
824	may include multiple service districts of the Department of
825	Children and Family Services.
826	5. Develop a mechanism for selecting the pool of children
827	and adolescents who meet the criteria specified in this section
828	for participating in the demonstration model.
829	6. Establish a pooled funding plan that allocates
830	proportionate costs to the purchasers. The plan must address all
831	of the service needs of the child or adolescent, and funds may
832	not be identified in the plan by legislative appropriation
833	category or any other state or federal funding category.
834	a. The funding plan shall be developed based on an
835	analysis of expenditures made by each participating state agency
836	during the previous 2 fiscal years in which services were
837	provided for the target population or for individuals who have
838	characteristics that are similar to the target population.
839	b. Based on the results of this cost analysis, funds shall
840	be collected from each of the participating state agencies and
841	deposited into a central financial account.
842	c. A financial body shall be designated to manage the pool
843	of funds and shall have the capability to pay for individual
844	services specified in a services plan.
845	7. Identify a care management entity that reports to the
846	oversight body. For purposes of the demonstration models, the
847	term "care management entity" means the entity that assumes
848	responsibility for the organization, planning, purchasing, and
849	management of mental health treatment services to the target
850	population in the demonstration model. The care management
851	entity may not provide direct services to the target population.
852	The care management entity shall:
853	a. Manage the funds of the demonstration model within
854	budget allocations. The administrative costs associated with the
855	operation of the demonstration model must be itemized in the
856	entity's operating budget.
857	b. Purchase individual services in a timely manner.
858	c. Review the completed client assessment information and
859	complete additional assessments that are needed, including an
860	assessment of the strengths of the child or adolescent and his
861	or her family.
862	d. Organize a child-family team to develop a single,
863	unified services plan for the child or adolescent, in accordance
864	with ss. 394.490-394.497. The team shall include the parents and
865	other family members of the child or adolescent, friends and
866	community-based supporters of the child or adolescent, and
867	appropriate service providers who are familiar with the problems
868	and needs of the child or adolescent and his or her family. The
869	plan must include a statement concerning the strengths of the
870	child or adolescent and his or her family, and must identify the
871	natural supports in the family and the community that might be
872	used in addressing the service needs of the child or adolescent.
873	A copy of the completed service plan shall be provided to the
874	parents of the child or adolescent.
875	e. Identify a network of providers that meet the
876	requirements of paragraph (b).
877	f. Identify informal, unpaid supporters, such as persons
878	from the child's or adolescent's neighborhood, civic
879	organizations, clubs, and churches.
880	g. Identify additional service providers who can work
881	effectively with the child or adolescent and his or her family,
882	including, but not limited to, a home health aide, mentor,
883	respite care worker, and in-home behavioral health care worker.
884	h. Implement a case management system that concentrates on
885	the strengths of the child or adolescent and his or her family
886	and uses these strengths in case planning and implementation
887	activities. The case manager is primarily responsible for
888	developing the services plan and shall report to the care
889	management entity. The case manager shall monitor and oversee
890	the services provided by the network of providers. The parents
891	must be informed about contacting the care management entity or
892	comparable entity to address concerns of the parents.
893
894	Each person or organization that performs any of the care
895	management responsibilities specified in this subparagraph is
896	responsible only to the care management entity. However, such
897	care management responsibilities do not preclude the person or
898	organization from performing other responsibilities for another
899	agency or provider.
900	8. Develop a mechanism for measuring compliance with the
901	goals of the demonstration models specified in subsection (2),
902	which mechanism includes qualitative and quantitative
903	performance outcomes, report on compliance rates, and conduct
904	quality improvement functions. At a minimum, the mechanism for
905	measuring compliance must include the outcomes and measures
906	established in the General Appropriations Act and the outcomes
907	and measures that are unique to the demonstration models.
908	9. Develop mechanisms to ensure that family
909	representatives have a substantial role in planning the
910	demonstration model and in designing the instrument for
911	measuring the effectiveness of services provided.
912	10. Develop and monitor grievance procedures.
913	11. Develop policies to ensure that a child or adolescent
914	is not rejected or ejected from the demonstration model because
915	of a clinical condition or a specific service need.
916	12. Develop policies to require that a participating state
917	agency remains a part of the demonstration model for its entire
918	duration.
919	13. Obtain training for the staff involved in all aspects
920	of the project.
921	(c) In order for children, adolescents, and families of
922	children and adolescents to receive timely and effective
923	services, the basic provider network identified in each
924	demonstration model must be well designed and managed. The
925	provider network should be able to meet the needs of a
926	significant proportion of the target population. The applicant
927	must demonstrate the capability to manage the network of
928	providers for the purchasers that participate in the
929	demonstration model. The applicant must demonstrate its ability
930	to perform the following network management functions:
931	1. Identify providers within the designated area of the
932	demonstration model which are currently funded by the state
933	agencies included in the model, and identify additional
934	providers that are needed to provide additional services for the
935	target population. The network of providers may include:
936	a. Licensed mental health professionals as defined in s.
937	394.455(2), (4), (22)(21), (24)(23), or (25)(24);
938	b. Professionals licensed under chapter 491;
939	c. Teachers certified under s. 1012.56;
940	d. Facilities licensed under chapter 395, as a hospital;
941	s. 394.875, as a crisis stabilization unit or short-term
942	residential facility; or s. 409.175, as a residential child-
943	caring agency; and
944	e. Other community agencies.
945	2. Define access points and service linkages of providers
946	in the network.
947	3. Define the ways in which providers and participating
948	state agencies are expected to collaborate in providing
949	services.
950	4. Define methods to measure the collective performance
951	outcomes of services provided by providers and state agencies,
952	measure the performance of individual agencies, and implement a
953	quality improvement process across the provider network.
954	5. Develop brochures for family members which are written
955	in understandable terminology, to help families identify
956	appropriate service providers, choose the provider, and access
957	care directly whenever possible.
958	6. Ensure that families are given a substantial role in
959	planning and monitoring the provider network.
960	7. Train all providers with respect to the principles of
961	care outlined in this section, including effective techniques of
962	cooperation, the wraparound process and strengths-based
963	assessment, the development of service plans, and techniques of
964	case management.
965	Section 10. Paragraph (d) of subsection (1) of section
966	419.001, Florida Statutes, is amended to read:
967	419.001 Site selection of community residential homes.--
968	(1) For the purposes of this section, the following
969	definitions shall apply:
970	(d) "Resident" means any of the following: a frail elder
971	as defined in s. 400.618; a physically disabled or handicapped
972	person as defined in s. 760.22(7)(a); a developmentally disabled
973	person as defined in s. 393.063(12); a nondangerous mentally ill
974	person as defined in s. 394.455(19)(18); or a child as defined
975	in s. 39.01(14), s. 984.03(9) or (12), or s. 985.03(8).
976	Section 11. Subsection (7) of section 744.704, Florida
977	Statutes, is amended to read:
978	744.704 Powers and duties.--
979	(7) A public guardian shall not commit a ward to a mental
980	health treatment facility, as defined in s. 394.455(32)(30),
981	without an involuntary placement proceeding as provided by law.
982	Section 12. The Department of Children and Family Services
983	may adopt any rules necessary to implement the provisions of
984	this act.
985	Section 13. If any provision of this act or its
986	application to any person or circumstance is held invalid, the
987	invalidity does not affect other provisions or applications of
988	the act which can be given effect without the invalid provision
989	or application, and to this end the provisions of this act are
990	severable.
991	Section 14. This act shall take effect October 1, 2004.