Florida Senate - 2013                                    SB 1736
       By Senator Altman
       16-01444-13                                           20131736__
    1                        A bill to be entitled                      
    2         An act relating to mental health; amending s. 394.463,
    3         F.S.; revising criteria for involuntary examination;
    4         specifying who may submit a petition for an ex parte
    5         order for involuntary examination; deleting a
    6         requirement that a less restrictive means be
    7         unavailable before a law enforcement officer may take
    8         a person into custody for an involuntary examination;
    9         providing a requirement for a report; revising
   10         discharge requirements if a person no longer meets the
   11         criteria for involuntary admission; amending s.
   12         394.469, F.S.; specifying when an involuntary patient
   13         is eligible for discharge; revising discharge
   14         requirements for involuntary patients; amending s.
   15         394.4625, F.S.; providing additional discharge
   16         requirements for voluntary patients; providing an
   17         effective date.
   19  Be It Enacted by the Legislature of the State of Florida:
   21         Section 1. Paragraph (b) of subsection (1) and paragraphs
   22  (a), (e), (g), and (h) of subsection (2) of section 394.463,
   23  Florida Statutes, are amended to read:
   24         394.463 Involuntary examination.—
   25         (1) CRITERIA.—A person may be taken to a receiving facility
   26  for involuntary examination if there is reason to believe that
   27  the person has a mental illness and because of his or her mental
   28  illness:
   29         (b)1. Without care or treatment, the person is likely to
   30  suffer from neglect or refuse to care for himself or herself
   31  and; such neglect or refusal poses a real and present threat of
   32  substantial harm to his or her well-being; and it is not
   33  apparent that such harm may be avoided through the help of
   34  willing family members or friends or the provision of other
   35  services; or
   36         2. There is a substantial likelihood that without care or
   37  treatment the person will cause serious bodily harm to himself
   38  or herself or others in the near future, as evidenced by recent
   39  behavior or a pattern of past behaviors causing, attempting, or
   40  threatening such harm.
   42         (a) An involuntary examination may be initiated by any one
   43  of the following means:
   44         1. A court may enter an ex parte order stating that a
   45  person appears to meet the criteria for involuntary examination,
   46  giving the findings on which that conclusion is based. The ex
   47  parte order for involuntary examination must be based on sworn
   48  testimony, written or oral. A representative of the department,
   49  a certified mental health case manager, a legal guardian, or an
   50  attorney may submit a petition for an ex parte order
   51  electronically to the court. If other less restrictive means are
   52  not available, such as voluntary appearance for outpatient
   53  evaluation, A law enforcement officer, or other designated agent
   54  of the court, shall take the person into custody and deliver him
   55  or her to the nearest receiving facility for involuntary
   56  examination. The order of the court shall be made a part of the
   57  patient’s clinical record. No fee shall be charged for the
   58  filing of an order under this subsection. Any receiving facility
   59  accepting the patient based on this order must send a copy of
   60  the order to the Agency for Health Care Administration on the
   61  next working day. The order shall be valid only until executed
   62  or, if not executed, for the period specified in the order
   63  itself. If no time limit is specified in the order, the order
   64  shall be valid for 7 days after the date that the order was
   65  signed.
   66         2. A law enforcement officer shall take a person who
   67  appears to meet the criteria for involuntary examination into
   68  custody and deliver the person or have him or her delivered to
   69  the nearest receiving facility for examination. The officer
   70  shall execute a written report detailing the circumstances under
   71  which the person was taken into custody, and the report shall be
   72  made a part of the patient’s clinical record. Any receiving
   73  facility accepting the patient based on this report must send a
   74  copy of the report to the Agency for Health Care Administration
   75  on the next working day.
   76         3. A physician, clinical psychologist, psychiatric nurse,
   77  mental health counselor, marriage and family therapist, or
   78  clinical social worker may execute a certificate stating that he
   79  or she has examined a person within the preceding 48 hours and
   80  finds that the person appears to meet the criteria for
   81  involuntary examination and stating the observations upon which
   82  that conclusion is based. If other less restrictive means are
   83  not available, such as voluntary appearance for outpatient
   84  evaluation, A law enforcement officer shall take the person
   85  named in the certificate into custody and deliver him or her to
   86  the nearest receiving facility for involuntary examination. The
   87  law enforcement officer shall execute a written report detailing
   88  the circumstances under which the person was taken into custody.
   89  The report and certificate shall be made a part of the patient’s
   90  clinical record. Any receiving facility accepting the patient
   91  based on this certificate must send a copy of the certificate to
   92  the Agency for Health Care Administration on the next working
   93  day.
   94         (e) The Agency for Health Care Administration shall receive
   95  and maintain the copies of ex parte orders, involuntary
   96  outpatient placement orders issued pursuant to s. 394.4655,
   97  involuntary inpatient placement orders issued pursuant to s.
   98  394.467, professional certificates, and law enforcement
   99  officers’ reports. These documents shall be considered part of
  100  the clinical record, governed by the provisions of s. 394.4615.
  101  The agency shall prepare annual reports analyzing the data
  102  obtained from these documents, without information identifying
  103  patients, and shall provide copies of reports to the department,
  104  the President of the Senate, the Speaker of the House of
  105  Representatives, and the minority leaders of the Senate and the
  106  House of Representatives. Each such report shall include the
  107  type of living arrangement the person was residing in at the
  108  time of intervention.
  109         (g) A person for whom an involuntary examination has been
  110  initiated who is being evaluated or treated at a hospital for an
  111  emergency medical condition specified in s. 395.002 must be
  112  examined by a receiving facility within 72 hours. The 72-hour
  113  period begins when the patient arrives at the hospital and
  114  ceases when the attending physician documents that the patient
  115  has an emergency medical condition. If a physician working in a
  116  hospital that provides emergency medical services believes that
  117  the patient no longer meets the criteria for involuntary
  118  admission to the hospital, the physician may discharge the
  119  patient to an appropriate setting that is able to meet the
  120  patient’s clinical needs and reduce the potential for
  121  incarceration, homelessness, or readmission. The physician shall
  122  determine the appropriate location for discharge if, in the
  123  judgment of the physician, the patient no longer meets criteria
  124  for involuntary admission to the hospital If the patient is
  125  examined at a hospital providing emergency medical services by a
  126  professional qualified to perform an involuntary examination and
  127  is found as a result of that examination not to meet the
  128  criteria for involuntary outpatient placement pursuant to s.
  129  394.4655(1) or involuntary inpatient placement pursuant to s.
  130  394.467(1), the patient may be offered voluntary placement, if
  131  appropriate, or released directly from the hospital providing
  132  emergency medical services. The finding by the professional that
  133  the patient has been examined and does not meet the criteria for
  134  involuntary inpatient placement or involuntary outpatient
  135  placement must be entered into the patient’s clinical record.
  136  Nothing in This paragraph does not is intended to prevent a
  137  hospital that provides providing emergency medical services from
  138  appropriately transferring a patient to another hospital before
  139  prior to stabilization, provided the requirements of s.
  140  395.1041(3)(c) have been met.
  141         (h) One of the following must occur within 12 hours after
  142  the patient’s attending physician documents that the patient’s
  143  medical condition has stabilized or that an emergency medical
  144  condition does not exist:
  145         1. The patient must be examined by a designated receiving
  146  facility and released to an appropriate setting or location that
  147  is able to meet the needs of the patient; or
  148         2. The patient must be transferred to a designated
  149  receiving facility in which appropriate medical treatment is
  150  available. However, the receiving facility must be notified of
  151  the transfer within 2 hours after the patient’s condition has
  152  been stabilized or after determination that an emergency medical
  153  condition does not exist.
  154         Section 2. Section 394.469, Florida Statutes, is amended to
  155  read:
  156         394.469 Discharge of involuntary patients.—
  157         (1) POWER TO DISCHARGE.—If at any time after the 72-hour
  158  observation period has been completed a patient is found to no
  159  longer meet the criteria for involuntary placement, the
  160  administrator shall:
  161         (a) Discharge the patient to a setting that is able to meet
  162  the patient’s clinical needs and would likely reduce the
  163  potential for readmission, incarceration, or homelessness,
  164  unless the patient is under a criminal charge, in which case the
  165  patient shall be transferred to the custody of the appropriate
  166  law enforcement officer;
  167         (b) Transfer the patient to voluntary status on his or her
  168  own authority or at the patient’s request, unless the patient is
  169  under criminal charge or adjudicated incapacitated; or
  170         (c) Place an improved patient, except a patient under a
  171  criminal charge, on convalescent status in the care of a
  172  community facility.
  173         (2) NOTICE.—Notice of discharge or transfer of a patient
  174  shall be given as provided in s. 394.4599.
  175         Section 3. Paragraph (c) is added to subsection (2) of
  176  section 394.4625, Florida Statutes, to read:
  177         394.4625 Voluntary admissions.—
  179         (c) A patient who is being discharged must be discharged to
  180  a location or setting that is able to meet the patient’s
  181  clinical needs in order to meet the goal of preventing
  182  readmission, incarceration, or homelessness. Placement in a
  183  homeless shelter or release without appropriate shelter does not
  184  meet the requirements of this paragraph.
  185         Section 4. This act shall take effect July 1, 2013.