Florida Statutes (Supplement 1996)

CHAPTER 394: MENTAL HEALTH

PART I FLORIDA MENTAL HEALTH ACT

394.453 Legislative intent. ---

It is the intent of the Legislature to authorize and direct the [Footnote
1] Department of Health and Rehabilitative Services to evaluate, research,
plan, and recommend to the Governor and the Legislature programs designed
to reduce the occurrence, severity, duration, and disabling aspects of
mental, emotional, and behavioral disorders. It is the intent of the
Legislature that treatment programs for such disorders shall include, but
not be limited to, comprehensive health, social, educational, and
rehabilitative services to persons requiring intensive short-term and
continued treatment in order to encourage them to assume responsibility for
their treatment and recovery. It is intended that such persons be provided
with emergency service and temporary detention for evaluation when
required; that they be admitted to treatment facilities on a voluntary
basis when extended or continuing care is needed and unavailable in the
community; that involuntary placement be provided only when expert
evaluation determines that it is necessary; that any involuntary treatment
or examination be accomplished in a setting which is clinically appropriate
and most likely to facilitate the person's return to the community as soon
as possible; and that individual dignity and human rights be guaranteed to
all persons who are admitted to mental health facilities or who are being
held under s. 394.463. It is the further intent of the Legislature that the
least restrictive means of intervention be employed based on the individual
needs of each person, within the scope of available services. History: s.
2, ch. 71-131; s. 198, ch. 77-147; s. 1, ch. 79-298; s. 4, ch. 82-212; s.
2, ch. 84-285; s. 10, ch. 85-54; s. 1, ch. 91-249; s. 1, ch. 96-169.
[Footnote 1] Note. The Department of Health and Rehabilitative Services was
redesignated as the Department of Children and Family Services by s. 5, ch.
96-403, and the Department of Health was created by s. 8, ch. 96-403.

394.455 Definitions. ---

As used in this part, unless the context clearly requires otherwise, the
term:

(1) "Administrator" means the chief administrative officer of a receiving
or treatment facility or his or her designee.

(2) "Clinical psychologist" means a psychologist as defined in s.
490.003(3) with 3 years of postdoctoral experience in the practice of
clinical psychology, inclusive of the experience required for licensure, or
a psychologist employed by a facility operated by the United States
Department of Veterans Affairs that qualifies as a receiving or treatment
facility under this part.

(3) "Clinical record" means all parts of the record required to be
maintained and includes all medical records, progress notes, charts, and
admission and discharge data, and all other information recorded by a
facility which pertains to the patient's hospitalization and treatment.

(4) "Clinical social worker" means a person licensed as a clinical social
worker under chapter 491.

(5) "Community facility" means any community service provider contracting
with the department to furnish substance abuse or mental health services
under part IV of this chapter.

(6) "Community mental health center or clinic" means a publicly funded,
not-for-profit center which contracts with the department for the provision
of inpatient, outpatient, day treatment, or emergency services.

(7) "Court," unless otherwise specified, means the circuit court.

(8) "Department" means the [Footnote 1] Department of Health and
Rehabilitative Services.

(9) "Express and informed consent" means consent voluntarily given in
writing, by a competent person, after sufficient explanation and disclosure
of the subject matter involved to enable the person to make a knowing and
willful decision without any element of force, fraud, deceit, duress, or
other form of constraint or coercion.

(10) "Facility" means any hospital, community facility, public or private
facility, or receiving or treatment facility providing for the evaluation,
diagnosis, care, treatment, training, or hospitalization of persons who
appear to have a mental illness or have been diagnosed as having a mental
illness. "Facility" does not include any program or entity licensed
pursuant to chapter 400.

(11) "Guardian" means the natural guardian of a minor, or a person
appointed by a court to act on behalf of a ward's person if the ward is a
minor or has been adjudicated incapacitated.

(12) "Guardian advocate" means a person appointed by a court to make
decisions regarding mental health treatment on behalf of a patient who has
been found incompetent to consent to treatment pursuant to this part. The
guardian advocate may be granted specific additional powers by written
order of the court, as provided in this part.

(13) "Hospital" means a facility licensed under chapter 395.

(14) "Incapacitated" means that a person has been adjudicated incapacitated
pursuant to part V of chapter 744 and a guardian of the person has been
appointed.

(15) "Incompetent to consent to treatment" means that a person's judgment
is so affected by his or her mental illness that the person lacks the
capacity to make a well-reasoned, willful, and knowing decision concerning
his or her medical or mental health treatment.

(16) "Law enforcement officer" means a law enforcement officer as defined
in s. 943.10.

(17) "Mental health overlay program" means a mobile service which provides
an independent examination for voluntary admissions and a range of
supplemental onsite services to persons with a mental illness in a
residential setting such as a nursing home, assisted living facility, adult
family-care home, or nonresidential setting such as an adult day care
center. Independent examinations provided pursuant to this part through a
mental health overlay program must only be provided under contract with the
department for this service or be attached to a public receiving facility
that is also a community mental health center.

(18) "Mental illness" means an impairment of the emotional processes that
exercise conscious control of one's actions or of the ability to perceive
or understand reality, which impairment substantially interferes with a
person's ability to meet the ordinary demands of living, regardless of
etiology. For the purposes of this part, the term does not include
retardation or developmental disability as defined in chapter 393,
intoxication, or conditions manifested only by antisocial behavior or
substance abuse impairment.

(19) "Mobile crisis response service" means a nonresidential crisis service
attached to a public receiving facility and available 24 hours a day, 7
days a week, through which immediate intensive assessments and
interventions, including screening for admission into a receiving facility,
take place for the purpose of identifying appropriate treatment services.

(20) "Patient" means any person who is held or accepted for mental health
treatment.

(21) "Physician" means a medical practitioner licensed under chapter 458 or
chapter 459 who has experience in the diagnosis and treatment of mental and
nervous disorders or a physician employed by a facility operated by the
United States Department of Veterans Affairs which qualifies as a receiving
or treatment facility under this part.

(22) "Private facility" means any hospital or facility operated by a
for-profit or not-for-profit corporation or association that provides
mental health services and is not a public facility.

(23) "Psychiatric nurse" means a registered nurse licensed under chapter
464 who has a master's degree or a doctorate in psychiatric nursing and 2
years of post-master's clinical experience under the supervision of a
physician.

(24) "Psychiatrist" means a medical practitioner licensed under chapter 458
or chapter 459 who has primarily diagnosed and treated mental and nervous
disorders for a period of not less than 3 years, inclusive of psychiatric
residency.

(25) "Public facility" means any facility that has contracted with the
department to provide mental health services to all persons, regardless of
their ability to pay, and is receiving state funds for such purpose.

(26) "Receiving facility" means any public or private facility designated
by the department to receive and hold involuntary patients under emergency
conditions or for psychiatric evaluation and to provide short-term
treatment. The term does not include a county jail.

(27) "Representative" means a person selected to receive notice of
proceedings during the time a patient is held in or admitted to a receiving
or treatment facility.

(28) "Secretary" means the Secretary of [Footnote 1] Health and
Rehabilitative Services.

(29) "Transfer evaluation" means the process, as approved by the
appropriate district office of the department, whereby a person who is
being considered for placement in a state treatment facility is first
evaluated for appropriateness of admission to the facility by a
community-based public receiving facility or by a community mental health
center or clinic if the public receiving facility is not a community mental
health center or clinic.

(30) "Treatment facility" means any state-owned, state-operated, or
state-supported hospital, center, or clinic designated by the department
for extended treatment and hospitalization, beyond that provided for by a
receiving facility, of persons who have a mental illness, including
facilities of the United States Government, and any private facility
designated by the department when rendering such services to a person
pursuant to the provisions of this part. Patients treated in facilities of
the United States Government shall be solely those whose care is the
responsibility of the United States Department of Veterans Affairs.
History: s. 3, ch. 71-131; s. 1, ch. 72-396; s. 1, ch. 73-133; s. 25, ch.
73-334; s. 199, ch. 77-147; s. 2, ch. 79-298; s. 1, ch. 80-398; s. 5, ch.
82-212; s. 46, ch. 83-218; s. 3, ch. 84-285; s. 11, ch. 85-54; s. 11, ch.
86-145; s. 10, ch. 87-238; s. 17, ch. 87-252; s. 41, ch. 89-526; s. 28, ch.
90-306; s. 21, ch. 92-33; s. 65, ch. 93-268; s. 705, ch. 95-148; s. 54, ch.
95-228; s. 2, ch. 96-169. [Footnote 1] Note. The Department of Health and
Rehabilitative Services was redesignated as the Department of Children and
Family Services by s. 5, ch. 96-403, and the Department of Health was
created by s. 8, ch. 96-403.

394.457 Operation and administration. ---

(1) ADMINISTRATION. The [Footnote 1] Department of Health and
Rehabilitative Services is designated the "Mental Health Authority" of
Florida. The department and the Agency for Health Care Administration shall
exercise executive and administrative supervision over all mental health
facilities, programs, and services.

(2) RESPONSIBILITIES OF THE DEPARTMENT. The department is responsible for:

(a) The planning, evaluation, and implementation of a complete and
comprehensive statewide program of mental health, including community
services, receiving and treatment facilities, child services, research, and
training as authorized and approved by the Legislature, based on the annual
program budget of the department. The department is also responsible for
the coordination of efforts with other departments and divisions of the
state government, county and municipal governments, and private agencies
concerned with and providing mental health services. It is responsible for
establishing standards, providing technical assistance, and exercising
supervision of mental health programs of, and the treatment of patients at,
community facilities, other facilities for persons who have a mental
illness, and any agency or facility providing services to patients pursuant
to this part.

(b) The publication and distribution of an information handbook to
facilitate understanding of this part, the policies and procedures involved
in the implementation of this part, and the responsibilities of the various
providers of services under this part. It shall stimulate research by
public and private agencies, institutions of higher learning, and hospitals
in the interest of the elimination and amelioration of mental illness.

(3) POWER TO CONTRACT. The department may contract to provide, and be
provided with, services and facilities in order to carry out its
responsibilities under this part with the following agencies: public and
private hospitals; receiving and treatment facilities; clinics;
laboratories; departments, divisions, and other units of state government;
the state colleges and universities; the community colleges; private
colleges and universities; counties, municipalities, and any other
governmental unit, including facilities of the United States Government;
and any other public or private entity which provides or needs facilities
or services. Baker Act funds for community inpatient, crisis stabilization,
short-term residential treatment, and screening services must be allocated
to each county pursuant to the department's funding allocation methodology.
Notwithstanding the provisions of s. 287.057(3) (f), contracts for
community-based Baker Act services for inpatient, crisis stabilization,
short-term residential treatment, and screening provided under this part,
other than those with other units of government, to be provided for the
department must be awarded using competitive sealed bids when the county
commission of the county receiving the services makes a request to the
department's district office by January 15 of the contracting year. The
district shall not enter into a competitively bid contract under this
provision if such action will result in increases of state or local
expenditures for Baker Act services within the district. Contracts for
these Baker Act services using competitive sealed bids will be effective
for 3 years. Services contracted for by the department may be reimbursed by
the state at a rate up to 100 percent. The department shall adopt rules
establishing minimum standards for such contracted services and facilities
and shall make periodic audits and inspections to assure that the
contracted services are provided and meet the standards of the department.

(4) APPLICATION FOR AND ACCEPTANCE OF GIFTS AND GRANTS. The department may
apply for and accept any funds, grants, gifts, or services made available
to it by any agency or department of the Federal Government or any other
public or private agency or individual in aid of mental health programs.
All such moneys shall be deposited in the State Treasury and shall be
disbursed as provided by law.

(5) RULES.

(a) The department shall adopt rules establishing forms and procedures
relating to the rights and privileges of patients seeking mental health
treatment from facilities under this part.

(b) The department shall adopt rules necessary for the implementation and
administration of the provisions of this part, and a program subject to the
provisions of this part shall not be permitted to operate unless rules
designed to ensure the protection of the health, safety, and welfare of the
patients treated through such program have been adopted.

(c) The department shall adopt rules establishing minimum standards for
services provided by a mental health overlay program or a mobile crisis
response service.

(6) PERSONNEL.

(a) The department shall, by rule, establish minimum standards of education
and experience for professional and technical personnel employed in mental
health programs, including members of a mobile crisis response service.

(b) The department shall design and distribute appropriate materials for
the orientation and training of persons actively engaged in implementing
the provisions of this part relating to the involuntary examination and
placement of persons who are believed to have a mental illness.

(7) PAYMENT FOR CARE OF PATIENTS. Fees and fee collections for patients in
state-owned, state-operated, or state-supported treatment facilities shall
be according to s. 402.33. History: s. 1, ch. 57-317; s. 1, ch. 59-222; s.
1, ch. 65-13; s. 3, ch. 65-22; s. 1, ch. 65-145; s. 1, ch. 67-334; ss. 11,
19, 31, 35, ch. 69-106; s. 4, ch. 71-131; s. 70, ch. 72-221; s. 2, ch.
72-396; s. 2, ch. 73-133; s. 25, ch. 73-334; s. 1, ch. 74-233; s. 200, ch.
77-147; s. 19, ch. 78-95; s. 3, ch. 78-332; s. 3, ch. 79-298; s. 6, ch.
82-212; s. 4, ch. 84-285; s. 12, ch. 85-54; s. 11, ch. 87-238; s. 2, ch.
90-225; s. 28, ch. 90-347; s. 7, ch. 91-33; s. 22, ch. 91-57; s. 89, ch.
91-221; s. 2, ch. 91-249; s. 11, ch. 93-156; s. 19, ch. 94-134; s. 19, ch.
94-135; s. 15, ch. 95-152; s. 37, ch. 95-228; s. 124, ch. 95-418; s. 3, ch.
96-169; s. 8, ch. 96-268; s. 209, ch. 96-406; s. 123, ch. 96-410. [Footnote
1] Note. The Department of Health and Rehabilitative Services was
redesignated as the Department of Children and Family Services by s. 5, ch.
96-403, and the Department of Health was created by s. 8, ch. 96-403. Note.
Former s. 965.01(3), s. 402.10.

394.4572 Screening of mental health personnel. ---

(1)

(a) The department and the Agency for Health Care Administration shall
require employment screening for mental health personnel using the
standards for level 2 screening set forth in chapter 435. "Mental health
personnel" includes all program directors, professional clinicians, staff
members, and volunteers working in public or private mental health programs
and facilities who have direct contact with unmarried patients under the
age of 18 years.

(b) Students in the health care professions who are interning in a mental
health facility licensed under chapter 395, where the primary purpose of
the facility is not the treatment of minors, are exempt from the
fingerprinting and screening requirements, provided they are under direct
supervision in the actual physical presence of a licensed health care
professional.

(c) Mental health personnel working in a facility licensed under chapter
395 who have less than 15 hours per week of direct contact with patients or
who are health care professionals licensed by the Agency for Health Care
Administration or a board thereunder are exempt from the fingerprinting and
screening requirements, except for persons working in mental health
facilities where the primary purpose of the facility is the treatment of
minors.

(d) A volunteer who assists on an intermittent basis for less than 40 hours
per month is exempt from the fingerprinting and screening requirements,
provided the volunteer is under direct and constant supervision by persons
who meet the screening requirements of paragraph (a).

(2) The department or the Agency for Health Care Administration may grant
exemptions from disqualification as provided in s. 435.06.

(3) Prospective mental health personnel who have previously been
fingerprinted or screened pursuant to this chapter, chapter 393, chapter
397, chapter 402, or chapter 409, or teachers who have been fingerprinted
pursuant to chapter 231, who have not been unemployed for more than 90 days
thereafter, and who under the penalty of perjury attest to the completion
of such fingerprinting or screening and to compliance with the provisions
of this section and the standards for level 1 screening contained in
chapter 435, shall not be required to be refingerprinted or rescreened in
order to comply with any screening requirements of this part. History: s.
1, ch. 87-128; s. 1, ch. 87-141; s. 23, ch. 93-39; s. 4, ch. 96-169.

394.4573 Continuity of care management system; measures of performance;
reports. ---

(1) For the purposes of this section:

(a) "Case management" means those activities aimed at assessing client
needs, planning services, linking the service system to a client,
coordinating the various system components, monitoring service delivery,
and evaluating the effect of service delivery.

(b) "Case manager" means an individual who works with clients, and their
families and significant others, to provide case management.

(c) "Client manager" means an employee of the department who is assigned to
specific provider agencies and geographic areas to ensure that the full
range of needed services is available to clients.

(d) "Continuity of care management system" means a system that assures,
within available resources, that clients have access to the full array of
services within the mental health services delivery system.

(2) The department is directed to implement a continuity of care management
system for the provision of mental health care, through the provision of
client and case management, including clients referred from state treatment
facilities to community mental health facilities. Such system shall include
a network of client managers and case managers throughout the state
designed to:

(a) Reduce the possibility of a client's admission or readmission to a
state treatment facility.

(b) Provide for the creation or designation of an agency in each county to
provide single intake services for each person seeking mental health
services. Such agency shall provide information and referral services
necessary to ensure that clients receive the most appropriate and least
restrictive form of care, based on the individual needs of the person
seeking treatment. Such agency shall have a single telephone number,
operating 24 hours per day, 7 days per week, where practicable, at a
central location, where each client will have a central record.

(c) Advocate on behalf of the client to ensure that all appropriate
services are afforded to the client in a timely and dignified manner.

(d) Require that any public receiving facility initiating a patient
transfer to a licensed hospital for acute care mental health services not
accessible through the public receiving facility shall notify the hospital
of such transfer and send all records relating to the emergency psychiatric
or medical condition.

(3) The department is directed to develop and include in contracts with
service providers measures of performance with regard to goals and
objectives as specified in the state plan. Such measures shall use, to the
extent practical, existing data collection methods and reports and shall
not require, as a result of this subsection, additional reports on the part
of service providers. The department shall plan monitoring visits of
community mental health facilities with other state, federal, and local
governmental and private agencies charged with monitoring such facilities.

(4) The department is directed to submit a report to the Legislature, prior
to April 1 of each year, outlining departmental progress towards the
implementation of the minimum staffing patterns' standards in state mental
health treatment facilities. The report shall contain, by treatment
facility, information regarding goals and objectives and departmental
performance toward meeting each such goal and objective. History: ss. 3, 4,
5, ch. 80-384; s. 5, ch. 84-285; s. 1, ch. 89-211; s. 5, ch. 96-169.

394.458 Introduction or removal of certain articles unlawful; penalty. ---

(1)

(a) Except as authorized by law or as specifically authorized by the person
in charge of each hospital providing mental health services under this
part, it is unlawful to introduce into or upon the grounds of such
hospital, or to take or attempt to take or send therefrom, any of the
following articles, which are hereby declared to be contraband for the
purposes of this section: 1. Any intoxicating beverage or beverage which
causes or may cause an intoxicating effect; 2. Any controlled substance as
defined in chapter 893; or 3. Any firearms or deadly weapon.

(b) It is unlawful to transmit to, or attempt to transmit to, or cause or
attempt to cause to be transmitted to, or received by, any patient of any
hospital providing mental health services under this part any article or
thing declared by this section to be contraband, at any place which is
outside of the grounds of such hospital, except as authorized by law or as
specifically authorized by the person in charge of such hospital.

(2) A person who violates any provision of this section commits a felony of
the third degree, punishable as provided in s. 775.082, s. 775.083, or s.
775.084. History: s. 1, ch. 75-253; s. 201, ch. 77-147; s. 1, ch. 77-174;
s. 6, ch. 96-169.

394.459 Rights of patients. ---

(1) RIGHT TO INDIVIDUAL DIGNITY. It is the policy of this state that the
individual dignity of the patient shall be respected at all times and upon
all occasions, including any occasion when the patient is taken into
custody, held, or transported. Procedures, facilities, vehicles, and
restraining devices utilized for criminals or those accused of crime shall
not be used in connection with persons who have a mental illness, except
for the protection of the patient or others. Persons who have a mental
illness but who are not charged with a criminal offense shall not be
detained or incarcerated in the jails of this state. A person who is
receiving treatment for mental illness in a facility shall not be deprived
of any constitutional rights. However, if such a person is adjudicated
incapacitated, his or her rights may be limited to the same extent the
rights of any incapacitated person are limited by law.

(2) RIGHT TO TREATMENT.

(a) A person shall not be denied treatment for mental illness and services
shall not be delayed at a receiving or treatment facility because of
inability to pay. However, every reasonable effort to collect appropriate
reimbursement for the cost of providing mental health services to persons
able to pay for services, including insurance or third-party payments,
shall be made by facilities providing services pursuant to this part.

(b) It is further the policy of the state that the least restrictive
appropriate available treatment be utilized based on the individual needs
and best interests of the patient and consistent with optimum improvement
of the patient's condition.

(c) Each person who remains at a receiving or treatment facility for more
than 12 hours shall be given a physical examination by a health
practitioner authorized by law to give such examinations, within 24 hours
after arrival at such facility.

(d) Every patient in a facility shall be afforded the opportunity to
participate in activities designed to enhance self-image and the beneficial
effects of other treatments, as determined by the facility.

(e) Not more than 5 days after admission to a facility, each patient shall
have and receive an individualized treatment plan in writing which the
patient has had an opportunity to assist in preparing and to review prior
to its implementation. The plan shall include a space for the patient's
comments.

(3) RIGHT TO EXPRESS AND INFORMED PATIENT CONSENT.

(a) Each patient entering a facility shall be asked to give express and
informed consent for admission and treatment. If the patient has been
adjudicated incapacitated or found to be incompetent to consent to
treatment, express and informed consent to treatment shall be sought
instead from the patient's guardian or guardian advocate. If the patient is
a minor, express and informed consent for admission and treatment shall
also be requested from the patient's guardian. Express and informed consent
for admission and treatment of a patient under 18 years of age shall be
required from the patient's guardian, unless the minor is seeking
outpatient crisis intervention services under s. 394.4784. Express and
informed consent for admission and treatment given by a patient who is
under 18 years of age shall not be a condition of admission when the
patient's guardian gives express and informed consent for the patient's
admission pursuant to s. 394.463 or s. 394.467. Prior to giving consent,
the following information shall be disclosed to the patient, or to the
patient's guardian if the patient is 18 years of age or older and has been
adjudicated incapacitated, or to the patient's guardian advocate if the
patient has been found to be incompetent to consent to treatment, or to
both the patient and the guardian if the patient is a minor: the reason for
admission, the proposed treatment, the purpose of the treatment to be
provided, the common side effects thereof, alternative treatment
modalities, the approximate length of care, and that any consent given by a
patient may be revoked orally or in writing prior to or during the
treatment period by the patient, the guardian advocate, or the guardian.

(b) In the case of medical procedures requiring the use of a general
anesthetic or electroconvulsive treatment, and prior to performing the
procedure, express and informed consent shall be obtained from the patient
if the patient is legally competent, from the guardian of a minor patient,
from the guardian of a patient who has been adjudicated incapacitated, or
from the guardian advocate of the patient if the guardian advocate has been
given express court authority to consent to medical procedures or
electroconvulsive treatment as provided under s. 394.4598.

(c) When the department is the legal guardian of a patient, or is the
custodian of a patient whose physician is unwilling to perform a medical
procedure, including an electroconvulsive treatment, based solely on the
patient's consent and whose guardian or guardian advocate is unknown or
unlocatable, the court shall hold a hearing to determine the medical
necessity of the medical procedure. The patient shall be physically
present, unless the patient's medical condition precludes such presence,
represented by counsel, and provided the right and opportunity to be
confronted with, and to cross-examine, all witnesses alleging the medical
necessity of such procedure. In such proceedings, the burden of proof by
clear and convincing evidence shall be on the party alleging the medical
necessity of the procedure.

(d) The administrator of a receiving or treatment facility may, upon the
recommendation of the patient's attending physician, authorize emergency
medical treatment, including a surgical procedure, if such treatment is
deemed lifesaving, or if the situation threatens serious bodily harm to the
patient, and permission of the patient or the patient's guardian or
guardian advocate cannot be obtained.

(4) QUALITY OF TREATMENT.

(a) Each patient in a facility shall receive services suited to his or her
needs, which shall be administered skillfully, safely, and humanely with
full respect for the patient's dignity and personal integrity. Each patient
shall receive such medical, vocational, social, educational, and
rehabilitative services as his or her condition requires to bring about an
early return to the community. In order to achieve this goal, the
department is directed to coordinate its mental health programs with all
other programs of the department and other state agencies.

(b) Receiving and treatment facilities shall develop and maintain, in a
form accessible to and readily understandable by patients, the following:
1. Criteria, procedures, and required staff training for any use of close
or elevated levels of supervision, of restraint, seclusion, or isolation,
or of emergency treatment orders, and for the use of bodily control and
physical management techniques. 2. Procedures for documenting, monitoring,
and requiring clinical review of all uses of the procedures described in
subparagraph 1. and for documenting and requiring review of any incidents
resulting in injury to patients. 3. A system for the review of complaints
by patients or their families or guardians.

(c) A facility may not use seclusion or restraint for punishment, to
compensate for inadequate staffing, or for the convenience of staff.
Facilities shall ensure that all staff are made aware of these restrictions
on the use of seclusion and restraint and shall make and maintain records
which demonstrate that this information has been conveyed to individual
staff members.

(5) COMMUNICATION, ABUSE REPORTING, AND VISITS.

(a) Each person receiving services in a facility providing mental health
services under this part has the right to communicate freely and privately
with persons outside the facility unless it is determined that such
communication is likely to be harmful to the person or others. Each
facility shall make available as soon as reasonably possible to persons
receiving services a telephone that allows for free local calls and access
to a long-distance service. A facility is not required to pay the costs of
a patient's long-distance calls. The telephone shall be readily accessible
to the patient and shall be placed so that the patient may use it to
communicate privately and confidentially. The facility may establish
reasonable rules for the use of this telephone, provided that the rules do
not interfere with a patient's access to a telephone to report abuse
pursuant to paragraph (e).

(b) Each patient admitted to a facility under the provisions of this part
shall be allowed to receive, send, and mail sealed, unopened
correspondence; and no patient's incoming or outgoing correspondence shall
be opened, delayed, held, or censored by the facility unless there is
reason to believe that it contains items or substances which may be harmful
to the patient or others, in which case the administrator may direct
reasonable examination of such mail and may regulate the disposition of
such items or substances.

(c) Each facility must permit immediate access to any patient, subject to
the patient's right to deny or withdraw consent at any time, by the
patient's family members, guardian, guardian advocate, representative,
human rights advocacy committee, or attorney, unless such access would be
detrimental to the patient. If a patient's right to communicate or to
receive visitors is restricted by the facility, written notice of such
restriction and the reasons for the restriction shall be served on the
patient, the patient's attorney, and the patient's guardian, guardian
advocate, or representative; and such restriction shall be recorded on the
patient's clinical record with the reasons therefor. The restriction of a
patient's right to communicate or to receive visitors shall be reviewed at
least every 7 days. The right to communicate or receive visitors shall not
be restricted as a means of punishment. Nothing in this paragraph shall be
construed to limit the provisions of paragraph (d).

(d) Each facility shall establish reasonable rules governing visitors,
visiting hours, and the use of telephones by patients in the least
restrictive possible manner. Patients shall have the right to contact and
to receive communication from their attorneys at any reasonable time.

(e) Each patient receiving mental health treatment in any facility shall
have ready access to a telephone in order to report an alleged abuse. The
facility staff shall orally and in writing inform each patient of the
procedure for reporting abuse and shall make every reasonable effort to
present the information in a language the patient understands. A written
copy of that procedure, including the telephone number of the abuse
registry and reporting forms, shall be posted in plain view.

(f) The department shall adopt rules providing a procedure for reporting
abuse. Facility staff shall be required, as a condition of employment, to
become familiar with the requirements and procedures for the reporting of
abuse.

(6) CARE AND CUSTODY OF PERSONAL EFFECTS OF PATIENTS. A patient's right to
the possession of his or her clothing and personal effects shall be
respected. The facility may take temporary custody of such effects when
required for medical and safety reasons. A patient's clothing and personal
effects shall be inventoried upon their removal into temporary custody.
Copies of this inventory shall be given to the patient and to the patient's
guardian, guardian advocate, or representative and shall be recorded in the
patient's clinical record. This inventory may be amended upon the request
of the patient or the patient's guardian, guardian advocate, or
representative. The inventory and any amendments to it must be witnessed by
two members of the facility staff and by the patient, if able. All of a
patient's clothing and personal effects held by the facility shall be
returned to the patient immediately upon the discharge or transfer of the
patient from the facility, unless such return would be detrimental to the
patient. If personal effects are not returned to the patient, the reason
must be documented in the clinical record along with the disposition of the
clothing and personal effects, which may be given instead to the patient's
guardian, guardian advocate, or representative. As soon as practicable
after an emergency transfer of a patient, the patient's clothing and
personal effects shall be transferred to the patient's new location,
together with a copy of the inventory and any amendments, unless an
alternate plan is approved by the patient, if able, and by the patient's
guardian, guardian advocate, or representative.

(7) VOTING IN PUBLIC ELECTIONS. A patient in a facility who is eligible to
vote according to the laws of the state has the right to vote in the
primary and general elections. The department shall establish rules to
enable patients to obtain voter registration forms, applications for
absentee ballots, and absentee ballots.

(8) HABEAS CORPUS.

(a) At any time, and without notice, a person held in a receiving or
treatment facility, or a relative, friend, guardian, guardian advocate,
representative, or attorney, or the department, on behalf of such person,
may petition for a writ of habeas corpus to question the cause and legality
of such detention and request that the court order a return to the writ in
accordance with chapter 79. Each patient held in a facility shall receive a
written notice of the right to petition for a writ of habeas corpus.

(b) At any time, and without notice, a person who is a patient in a
receiving or treatment facility, or a relative, friend, guardian, guardian
advocate, representative, or attorney, or the department, on behalf of such
person, may file a petition in the circuit court in the county where the
patient is being held alleging that the patient is being unjustly denied a
right or privilege granted herein or that a procedure authorized herein is
being abused. Upon the filing of such a petition, the court shall have the
authority to conduct a judicial inquiry and to issue any order needed to
correct an abuse of the provisions of this part.

(c) The administrator of any receiving or treatment facility receiving a
petition under this subsection shall file the petition with the clerk of
the court on the next court working day.

(d) No fee shall be charged for the filing of a petition under this
subsection.

(9) VIOLATIONS. The department shall report to the Agency for Health Care
Administration any violation of the rights or privileges of patients, or of
any procedures provided under this part, by any facility or professional
licensed or regulated by the agency. The agency is authorized to impose any
sanction authorized for violation of this part, based solely on the
investigation and findings of the department.

(10) LIABILITY FOR VIOLATIONS. Any person who violates or abuses any rights
or privileges of patients provided by this part is liable for damages as
determined by law. Any person who acts in good faith in compliance with the
provisions of this part is immune from civil or criminal liability for his
or her actions in connection with the admission, diagnosis, treatment, or
discharge of a patient to or from a facility. However, this section does
not relieve any person from liability if such person commits negligence.

(11) RIGHT TO PARTICIPATE IN TREATMENT AND DISCHARGE PLANNING. The patient
shall have the opportunity to participate in treatment and discharge
planning and shall be notified in writing of his or her right, upon
discharge from the facility, to seek treatment from the professional or
agency of the patient's choice.

(12) POSTING OF NOTICE OF RIGHTS OF PATIENTS. Each facility shall post a
notice listing and describing, in the language and terminology that the
persons to whom the notice is addressed can understand, the rights provided
in this section. This notice shall include a statement that provisions of
the federal Americans with Disabilities Act apply and the name and
telephone number of a person to contact for further information. This
notice shall be posted in a place readily accessible to patients and in a
format easily seen by patients. This notice shall include the telephone
numbers of the local human rights advocacy committee and Advocacy Center
for Persons with Disabilities, Inc. History: s. 5, ch. 71-131; s. 3, ch.
73-133; s. 25, ch. 73-334; s. 2, ch. 74-233; s. 202, ch. 77-147; s. 1, ch.
78-434; s. 12, ch. 79-3; s. 4, ch. 79-298; s. 10, ch. 79-320; s. 1, ch.
80-171; s. 7, ch. 82-212; s. 6, ch. 84-285; s. 27, ch. 85-167; s. 1, ch.
88-307; s. 16, ch. 88-398; s. 11, ch. 90-347; s. 1, ch. 91-170; s. 71, ch.
95-143; s. 706, ch. 95-148; s. 7, ch. 96-169; s. 210, ch. 96-406.

394.4595 Human Rights Advocacy Committee access to patients and records.
---

Any facility designated by the department as a receiving or treatment
facility must allow access to any patient and the clinical and legal
records of any patient admitted pursuant to the provisions of this act by
members of the Human Rights Advocacy Committee. History: s. 8, ch. 96-169.

394.4597 Persons to be notified; patient's representative. ---

(1) VOLUNTARY PATIENTS. At the time a patient is voluntarily admitted to a
receiving or treatment facility, the identity and contact information of a
person to be notified in case of an emergency shall be entered in the
patient's clinical record.

(2) INVOLUNTARY PATIENTS.

(a) At the time a patient is admitted to a facility for involuntary
examination or placement, or when a petition for involuntary placement is
filed, the names, addresses, and telephone numbers of the patient's
guardian or guardian advocate, or representative if the patient has no
guardian, and the patient's attorney shall be entered in the patient's
clinical record.

(b) If the patient has no guardian, the patient shall be asked to designate
a representative. If the patient is unable or unwilling to designate a
representative, the facility shall select a representative.

(c) The patient shall be consulted with regard to the selection of a
representative by the receiving or treatment facility and shall have
authority to request that any such representative be replaced.

(d) When the receiving or treatment facility selects a representative,
first preference shall be given to a health care surrogate, if one has been
previously selected by the patient. If the patient has not previously
selected a health care surrogate, the selection, except for good cause
documented in the patient's clinical record, shall be made from the
following list in the order of listing: 1. The patient's spouse. 2. An
adult child of the patient. 3. A parent of the patient. 4. The adult next
of kin of the patient. 5. An adult friend of the patient. 6. The
appropriate human rights advocacy committee as provided in s. 402.166.

(e) A licensed professional providing services to the patient under this
part, an employee of a facility providing direct services to the patient
under this part, a department employee, a person providing other
substantial services to the patient in a professional or business capacity,
or a creditor of the patient shall not be appointed as the patient's
representative. History: s. 9, ch. 96-169.

394.4598 Guardian advocate. ---

(1) The administrator may petition the court for the appointment of a
guardian advocate based upon the opinion of a psychiatrist that the patient
is incompetent to consent to treatment. If the court finds that a patient
is incompetent to consent to treatment and has not been adjudicated
incapacitated and a guardian with the authority to consent to mental health
treatment appointed, it shall appoint a guardian advocate. The patient has
the right to have an attorney represent him at the hearing. If the person
is indigent, the court shall appoint the office of the public defender to
represent him at the hearing. The patient has the right to testify,
cross-examine witnesses, and present witnesses. The proceeding shall be
recorded either electronically or stenographically, and testimony shall be
provided under oath. One of the professionals authorized to give an opinion
in support of a petition for involuntary placement, as described in s.
394.467(2), must testify. A guardian advocate must meet the qualifications
of a guardian contained in part IV of chapter 744, except that a
professional referred to in this part, an employee of the facility
providing direct services to the patient under this part, a departmental
employee, a facility administrator, or member of the district human rights
advocacy committee shall not be appointed. A person who is appointed as a
guardian advocate must agree to the appointment.

(2) A facility requesting appointment of a guardian advocate must, prior to
the appointment, provide the prospective guardian advocate with information
about the duties and responsibilities of guardian advocates, including the
information about the ethics of medical decisionmaking. Before asking a
guardian advocate to give consent to treatment for a patient, the facility
shall provide to the guardian advocate sufficient information so that the
guardian advocate can decide whether to give express and informed consent
to the treatment, including information that the treatment is essential to
the care of the patient, and that the treatment does not present an
unreasonable risk of serious, hazardous, or irreversible side effects.
Before giving consent to treatment, the guardian advocate must meet and
talk with the patient and the patient's physician in person, if at all
possible, and by telephone, if not. The decision of the guardian advocate
may be reviewed by the court, upon petition of the patient's attorney, the
patient's family, or the facility administrator.

(3) Prior to a guardian advocate exercising his authority, the guardian
advocate shall attend a training course approved by the court. This
training course, of not less than 4 hours, must include, at minimum,
information about the patient rights, psychotropic medications, diagnosis
of mental illness, the ethics of medical decisionmaking, and duties of
guardian advocates. This training course shall take the place of the
training required for guardians appointed pursuant to chapter 744.

(4) The information to be supplied to prospective guardian advocates prior
to their appointment and the training course for guardian advocates must be
developed and completed through a course developed by the department and
approved by the chief judge of the circuit court and taught by a
court-approved organization. Court-approved organizations may include, but
are not limited to, community or junior colleges, guardianship
organizations, and the local bar association or The Florida Bar. The court
may, in its discretion, waive some or all of the training requirements for
guardian advocates or impose additional requirements. The court shall make
its decision on a case-by-case basis and, in making its decision, shall
consider the experience and education of the guardian advocate, the duties
assigned to the guardian advocate, and the needs of the patient.

(5) In selecting a guardian advocate, the court shall give preference to a
health care surrogate, if one has already been designated by the patient.
If the patient has not previously selected a health care surrogate, except
for good cause documented in the court record, the selection shall be made
from the following list in the order of listing:

(a) The patient's spouse.

(b) An adult child of the patient.

(c) A parent of the patient.

(d) The adult next of kin of the patient.

(e) An adult friend of the patient.

(f) An adult trained and willing to serve as guardian advocate for the
patient.

(6) If a guardian with the authority to consent to medical treatment has
not already been appointed or if the patient has not already designated a
health care surrogate, the court may authorize the guardian advocate to
consent to medical treatment, as well as mental health treatment. Unless
otherwise limited by the court, a guardian advocate with authority to
consent to medical treatment shall have the same authority to make health
care decisions and be subject to the same restrictions as a proxy appointed
under part IV of chapter 765. Unless the guardian advocate has sought and
received express court approval in proceeding separate from the proceeding
to determine the competence of the patient to consent to medical treatment,
the guardian advocate may not consent to:

(a) Abortion.

(b) Sterilization.

(c) Electroconvulsive treatment.

(d) Psychosurgery.

(e) Experimental treatments that have not been approved by a federally
approved institutional review board in accordance with 45 C.F.R. part 46 or
21 C.F.R. part 56. The court must base its decision on evidence that the
treatment or procedure is essential to the care of the patient and that the
treatment does not present an unreasonable risk of serious, hazardous, or
irreversible side effects. The court shall follow the procedures set forth
in subsection (1) of this section.

(7) The guardian advocate shall be discharged when the patient is
discharged from a receiving or treatment facility to the community or when
the patient is transferred from involuntary to voluntary status. The court
or a hearing officer shall consider the competence of the patient pursuant
to subsection (1) and may consider an involuntarily placed patient's
competence to consent to treatment at any hearing. Upon sufficient
evidence, the court may restore, or the hearing officer may recommend that
the court restore, the patient's competence. A copy of the order restoring
competence or the certificate of discharge containing the restoration of
competence shall be provided to the patient and the guardian advocate.
History: s. 10, ch. 96-169.

394.4599 Notice. ---

(1) VOLUNTARY PATIENTS. Notice of a voluntary patient's admission shall
only be given at the request of the patient, except that in an emergency,
notice shall be given as determined by the facility.

(2) INVOLUNTARY PATIENTS.

(a) Whenever notice is required to be given under this part, such notice
shall be given to the patient and the patient's guardian, guardian
advocate, attorney, and representative. 1. When notice is required to be
given to a patient, it shall be given both orally and in writing, in the
language and terminology that the patient can understand, and, if needed,
the facility shall provide an interpreter for the patient. 2. Notice to a
patient's guardian, guardian advocate, attorney, and representative shall
be given by United States mail and by registered or certified mail with the
receipts attached to the patient's clinical record. Hand delivery by a
facility employee may be used as an alternative, with delivery documented
in the clinical record. If notice is given by a state attorney or an
attorney for the department, a certificate of service shall be sufficient
to document service.

(b) A receiving facility shall give prompt notice of the whereabouts of a
patient who is being involuntarily held for examination, by telephone or in
person within 24 hours after the patient's arrival at the facility, unless
the patient requests that no notification be made. Contact attempts shall
be documented in the patient's clinical record and shall begin as soon as
reasonably possible after the patient's arrival. Notice that a patient is
being admitted as an involuntary patient shall be given to the local human
rights advocacy committee no later than the next working day after the
patient is admitted.

(c) The written notice of the filing of the petition for involuntary
placement must contain the following: 1. Notice that the petition has been
filed with the circuit court in the county in which the patient is
hospitalized and the address of such court. 2. Notice that the office of
the public defender has been appointed to represent the patient in the
proceeding, if the patient is not otherwise represented by counsel. 3. The
date, time, and place of the hearing and the name of each examining expert
and every other person expected to testify in support of continued
detention. 4. Notice that the patient, the patient's guardian or
representative, or the administrator may apply for a change of venue for
the convenience of the parties or witnesses or because of the condition of
the patient. 5. Notice that the patient is entitled to an independent
expert examination and, if the patient cannot afford such an examination,
that the court will provide for one.

(d) A treatment facility shall provide notice of a patient's involuntary
admission on the next regular working day after the patient's arrival at
the facility.

(e) When a patient is to be transferred from one facility to another,
notice shall be given by the facility where the patient is located prior to
the transfer. History: s. 11, ch. 96-169.

394.460 Rights of professionals. ---

No professional referred to in this part shall be required to accept
patients for treatment of mental, emotional, or behavioral disorders. Such
participation shall be voluntary. History: s. 4, ch. 73-133; s. 5, ch.
79-298; s. 8, ch. 82-212; s. 12, ch. 96-169.

394.461 Designation of receiving and treatment facilities. ---

The department is authorized to designate and monitor receiving facilities
and treatment facilities and may suspend or withdraw such designation for
failure to comply with this part and rules adopted under this part. Unless
designated by the department, facilities are not permitted to hold or treat
involuntary patients under this part.

(1) RECEIVING FACILITY. The department may designate any community facility
as a receiving facility. Any other facility within the state, including a
private facility or a federal facility, may be so designated by the
department, provided that such designation is agreed to by the governing
body or authority of the facility.

(2) TREATMENT FACILITY. The department may designate any state-owned,
state-operated, or state-supported facility as a state treatment facility.
A civil patient shall not be admitted to a state treatment facility without
previously undergoing a transfer evaluation. Before a court hearing for
involuntary placement in a state treatment facility, the court shall
receive and consider the information documented in the transfer evaluation.
Any other facility, including a private facility or a federal facility, may
be designated as a treatment facility by the department, provided that such
designation is agreed to by the appropriate governing body or authority of
the facility.

(3) PRIVATE FACILITIES. Private facilities designated as receiving and
treatment facilities by the department may provide examination and
treatment of involuntary patients, as well as voluntary patients, and are
subject to all the provisions of this part.

(4) RULES. The department shall adopt rules relating to:

(a) Procedures and criteria for receiving and evaluating facility
applications for designation, which may include onsite facility inspection
and evaluation of an applicant's licensing status and performance history,
as well as consideration of local service needs.

(b) Minimum standards consistent with this part that a facility must meet
and maintain in order to be designated as a receiving or treatment facility
and procedures for monitoring continued adherence to such standards.

(c) Procedures for receiving complaints against a designated facility and
for initiating inspections and investigations of facilities alleged to have
violated the provisions of this part or rules adopted under this part.

(d) Procedures and criteria for the suspension or withdrawal of
designation. History: s. 6, ch. 71-131; s. 3, ch. 72-396; s. 5, ch. 73-133;
s. 1, ch. 77-90; s. 203, ch. 77-147; s. 6, ch. 79-298; ss. 1, 2, ch.
80-384; s. 9, ch. 82-212; s. 7, ch. 84-285; s. 42, ch. 85-167; s. 707, ch.
95-148; s. 13, ch. 96-169.

394.4615 Clinical records; confidentiality. ---

(1) A clinical record shall be maintained for each patient. The record
shall include data pertaining to admission and such other information as
may be required under rules of the department. A clinical record is
confidential and exempt from the provisions of s. 119.07(1). Unless waived
by express and informed consent, by the patient or the patient's guardian
or guardian advocate or, if the patient is deceased, by the patient's
personal representative or the family member who stands next in line of
intestate succession, the confidential status of the clinical record shall
not be lost by either authorized or unauthorized disclosure to any person,
organization, or agency.

(2) The clinical record shall be released when:

(a) The patient or the patient's guardian authorizes the release. The
guardian or guardian advocate shall be provided access to the appropriate
clinical records of the patient. The patient or the patient's guardian or
guardian advocate may authorize the release of information and clinical
records to appropriate persons to ensure the continuity of the patient's
health care or mental health care.

(b) The patient is represented by counsel and the records are needed by the
patient's counsel for adequate representation.

(c) The court orders such release. In determining whether there is good
cause for disclosure, the court shall weigh the need for the information to
be disclosed against the possible harm of disclosure to the person to whom
such information pertains.

(d) The patient is committed to, or is to be returned to, the Department of
Corrections from the [Footnote 1] Department of Health and Rehabilitative
Services, and the Department of Corrections requests such records. These
records shall be furnished without charge to the Department of Corrections.

(3) Information from the clinical record may be released when:

(a) A patient has declared an intention to harm other persons. When such
declaration has been made, the administrator may authorize the release of
sufficient information to provide adequate warning to the person threatened
with harm by the patient.

(b) The administrator of the facility or secretary of the department deems
release to a qualified researcher as defined in administrative rule, an
aftercare treatment provider, or an employee or agent of the department is
necessary for treatment of the patient, maintenance of adequate records,
compilation of treatment data, aftercare planning, or evaluation of
programs.

(4) Information from clinical records may be used for statistical and
research purposes if the information is abstracted in such a way as to
protect the identity of individuals.

(5) Information from clinical records may be used by the Agency for Health
Care Administration, the department, and the human rights advocacy
committees for the purpose of monitoring facility activity and complaints
concerning facilities.

(6) Any person, agency, or entity receiving information pursuant to this
section shall maintain such information as confidential and exempt from the
provisions of s. 119.07(1).

(7) Any facility or private mental health practitioner who acts in good
faith in releasing information pursuant to this section is not subject to
civil or criminal liability for such release.

(8) Nothing in this section is intended to prohibit the parent or next of
kin of a person who is held in or treated under a mental health facility or
program from requesting and receiving information limited to a summary of
that person's treatment plan and current physical and mental condition.
Release of such information shall be in accordance with the code of ethics
of the profession involved.

(9) Patients shall have reasonable access to their clinical records, unless
such access is determined by the patient's physician to be harmful to the
patient. If the patient's right to inspect his or her clinical record is
restricted by the facility, written notice of such restriction shall be
given to the patient and the patient's guardian, guardian advocate,
attorney, and representative. In addition, the restriction shall be
recorded in the clinical record, together with the reasons for it. The
restriction of a patient's right to inspect his or her clinical record
shall expire after 7 days but may be renewed, after review, for subsequent
7-day periods.

(10) Any person who fraudulently alters, defaces, or falsifies the clinical
record of any person receiving mental health services in a facility subject
to this part, or causes or procures any of these offenses to be committed,
commits a misdemeanor of the second degree, punishable as provided in s.
775.082 or s. 775.083. History: s. 14, ch. 96-169. [Footnote 1] Note. The
Department of Health and Rehabilitative Services was redesignated as the
Department of Children and Family Services by s. 5, ch. 96-403, and the
Department of Health was created by s. 8, ch. 96-403.

394.462 Transportation. ---

(1) TRANSPORTATION TO A RECEIVING FACILITY.

(a) Each county shall designate a single law enforcement agency within the
county, or portions thereof, to take a person into custody upon the entry
of an ex parte order or the execution of a certificate for involuntary
examination by an authorized professional and to transport that person to
the nearest receiving facility for examination. The designated law
enforcement agency may decline to transport the person to a receiving
facility only if: 1. The jurisdiction designated by the county has
contracted on an annual basis with an emergency medical transport service
or private transport company for transportation of persons to receiving
facilities pursuant to this section at the sole cost of the county; and 2.
The law enforcement agency and the emergency medical transport service or
private transport company agree that the continued presence of law
enforcement personnel is not necessary for the safety of the person or
others. 3. The jurisdiction designated by the county may seek reimbursement
for transportation expenses. The party responsible for payment for such
transportation is the person receiving the transportation. The county shall
seek reimbursement from the following sources in the following order: a.
From an insurance company, health care corporation, or other source, if the
person receiving the transportation is covered by an insurance policy or
subscribes to a health care corporation or other source for payment of such
expenses. b. From the person receiving the transportation. c. From a
financial settlement for medical care, treatment, hospitalization, or
transportation payable or accruing to the injured party.

(b) Any company that transports a patient pursuant to this subsection is
considered an independent contractor and is solely liable for the safe and
dignified transportation of the patient. Such company must be insured and
provide no less than $100,000 in liability insurance with respect to the
transportation of patients.

(c) Any company that contracts with a governing board of a county to
transport patients shall comply with the applicable rules of the department
to ensure the safety and dignity of the patients.

(d) When a law enforcement officer takes custody of a person pursuant to
this part, the officer may request assistance from emergency medical
personnel if such assistance is needed for the safety of the officer or the
person in custody.

(e) When a member of a mental health overlay program or a mobile crisis
response service is a professional authorized to initiate an involuntary
examination pursuant to s. 394.463 and that professional evaluates a person
and determines that transportation to a receiving facility is needed, the
service, at its discretion, may transport the person to the facility or may
call on the law enforcement agency or other transportation arrangement best
suited to the needs of the patient.

(f) When any law enforcement officer has custody of a person based on
either noncriminal or minor criminal behavior that meets the statutory
guidelines for involuntary examination under this part, the law enforcement
officer shall transport the person to the nearest receiving facility for
examination.

(g) When any law enforcement officer has arrested a person for a felony and
it appears that the person meets the statutory guidelines for involuntary
examination or placement under this part, such person shall first be
processed in the same manner as any other criminal suspect. The law
enforcement agency shall thereafter immediately notify the nearest public
receiving facility, which shall be responsible for promptly arranging for
the examination and treatment of the person. A receiving facility is not
required to admit a person charged with a crime for whom the facility
determines and documents that it is unable to provide adequate security,
but shall provide mental health examination and treatment to the person
where he or she is held.

(h) If the appropriate law enforcement officer believes that a person has
an emergency medical condition as defined in s. 395.002, the person may be
first transported to a hospital for emergency medical treatment, regardless
of whether the hospital is a designated receiving facility.

(i) The costs of transportation, evaluation, hospitalization, and treatment
incurred under this subsection by persons who have been arrested for
violations of any state law or county or municipal ordinance may be
recovered as provided in s. 901.35.

(j) The nearest receiving facility must accept persons brought by law
enforcement officers for involuntary examination.

(k) When a jurisdiction has entered into a contract with an emergency
medical transport service or a private transport company for transportation
of persons to receiving facilities, such service or company shall be given
preference for transportation of persons from nursing homes, assisted
living facilities, adult day care centers, or adult family-care homes,
unless the behavior of the person being transported is such that
transportation by a law enforcement officer is necessary.

(l) Nothing in this section shall be construed to limit emergency
examination and treatment of incapacitated persons provided in accordance
with the provisions of s. 401.445.

(2) TRANSPORTATION TO A TREATMENT FACILITY.

(a) If neither the patient nor any person legally obligated or responsible
for the patient is able to pay for the expense of transporting a voluntary
or involuntary patient to a treatment facility, the governing board of the
county in which the patient is hospitalized shall arrange for such required
transportation and shall ensure the safe and dignified transportation of
the patient. The governing board of each county is authorized to contract
with private transport companies for the transportation of such patients to
and from a treatment facility.

(b) Any company that transports a patient pursuant to this subsection is
considered an independent contractor and is solely liable for the safe and
dignified transportation of the patient. Such company must be insured and
provide no less than $100,000 in liability insurance with respect to the
transportation of patients.

(c) Any company that contracts with the governing board of a county to
transport patients shall comply with the applicable rules of the department
to ensure the safety and dignity of the patients.

(d) County or municipal law enforcement and correctional personnel and
equipment shall not be used to transport patients adjudicated incapacitated
or found by the court to meet the criteria for involuntary placement
pursuant to s. 394.467, except in small rural counties where there are no
cost-efficient alternatives.

(3) EXCEPTIONS. An exception to the requirements of this section may be
granted by the secretary of the department for the purposes of improving
service coordination or better meeting the special needs of individuals. A
proposal for an exception must be submitted by the district administrator
after being approved by the local health and human services board and by
the governing boards of any affected counties, prior to submission to the
secretary.

(a) A proposal for an exception must identify the specific provision from
which an exception is requested; describe how the proposal will be
implemented by participating law enforcement agencies and transportation
authorities; and provide a plan for the coordination of services such as
case management.

(b) The exception may be granted only for: 1. An arrangement centralizing
and improving the provision of services within a district, which may
include an exception to the requirement for transportation to the nearest
receiving facility; 2. An arrangement by which a facility may provide, in
addition to required psychiatric services, an environment and services
which are uniquely tailored to the needs of an identified group of persons
with special needs, such as persons with hearing impairments or visual
impairments, or elderly persons with physical frailties; or 3. A
specialized transportation system that provides an efficient and humane
method of transporting patients to receiving facilities, among receiving
facilities, and to treatment facilities.

(c) Any exception approved pursuant to this subsection shall be reviewed
and approved every 5 years by the secretary. History: s. 15, ch. 96-169.

394.4625 Voluntary admissions. ---

(1) AUTHORITY TO RECEIVE PATIENTS.

(a) A facility may receive for observation, diagnosis, or treatment any
person 18 years of age or older making application by express and informed
consent for admission or any person age 17 or under for whom such
application is made by his or her guardian. If found to show evidence of
mental illness, to be competent to provide express and informed consent,
and to be suitable for treatment, such person 18 years of age or older may
be admitted to the facility. A person age 17 or under may be admitted only
after a hearing to verify the voluntariness of the consent.

(b) A mental health overlay program or a mobile crisis response service or
a licensed professional who is authorized to initiate an involuntary
examination pursuant to s. 394.463 and is employed by a community mental
health center or clinic must, pursuant to district procedure approved by
the respective district administrator, conduct an initial assessment of the
ability of the following persons to give express and informed consent to
treatment before such persons may be admitted voluntarily: 1. A person 60
years of age or older for whom transfer is being sought from a nursing
home, assisted living facility, adult day care center, or adult family-care
home, when such person has been diagnosed as suffering from dementia. 2. A
person 60 years of age or older for whom transfer is being sought from a
nursing home pursuant to s. 400.0255(6). 3. A person for whom all decisions
concerning medical treatment are currently being lawfully made by the
health care surrogate or proxy designated under chapter 765.

(c) When an initial assessment of the ability of a person to give express
and informed consent to treatment is required under this section, and a
mobile crisis response service does not respond to the request for an
assessment within 2 hours after the request is made or informs the
requesting facility that it will not be able to respond within 2 hours
after the request is made, the requesting facility may arrange for
assessment by any licensed professional authorized to initiate an
involuntary examination pursuant to s. 394.463 who is not employed by or
under contract with, and does not have a financial interest in, either the
facility initiating the transfer or the receiving facility to which the
transfer may be made.

(d) A facility may not admit as a voluntary patient a person who has been
adjudicated incapacitated, unless the condition of incapacity has been
judicially removed. If a facility admits as a voluntary patient a person
who is later determined to have been adjudicated incapacitated, and the
condition of incapacity had not been removed by the time of the admission,
the facility must either discharge the patient or transfer the patient to
involuntary status.

(e) The health care surrogate or proxy of a voluntary patient may not
consent to the provision of mental health treatment for the patient. A
voluntary patient who is unwilling or unable to provide express and
informed consent to mental health treatment must either be discharged or
transferred to involuntary status.

(f) Within 24 hours after admission of a voluntary patient, the admitting
physician shall document in the patient's clinical record that the patient
is able to give express and informed consent for admission. If the patient
is not able to give express and informed consent for admission, the
facility shall either discharge the patient or transfer the patient to
involuntary status pursuant to subsection (5).

(2) DISCHARGE OF VOLUNTARY PATIENTS.

(a) A facility shall discharge a voluntary patient: 1. Who has sufficiently
improved so that retention in the facility is no longer desirable. A
patient may also be discharged to the care of a community facility. 2. Who
revokes consent to admission or requests discharge. A voluntary patient or
a relative, friend, or attorney of the patient may request discharge either
orally or in writing at any time following admission to the facility. The
patient must be discharged within 24 hours of the request, unless the
request is rescinded or the patient is transferred to involuntary status
pursuant to this section. The 24-hour time period may be extended by a
treatment facility when necessary for adequate discharge planning, but
shall not exceed 3 days exclusive of weekends and holidays. If the patient,
or another on the patient's behalf, makes an oral request for discharge to
a staff member, such request shall be immediately entered in the patient's
clinical record. If the request for discharge is made by a person other
than the patient, the discharge may be conditioned upon the express and
informed consent of the patient.

(b) A voluntary patient who has been admitted to a facility and who refuses
to consent to or revokes consent to treatment shall be discharged within 24
hours after such refusal or revocation, unless transferred to involuntary
status pursuant to this section or unless the refusal or revocation is
freely and voluntarily rescinded by the patient.

(3) NOTICE OF RIGHT TO DISCHARGE. At the time of admission and at least
every 6 months thereafter, a voluntary patient shall be notified in writing
of his or her right to apply for a discharge.

(4) TRANSFER TO VOLUNTARY STATUS. An involuntary patient who applies to be
transferred to voluntary status shall be transferred to voluntary status
immediately, unless the patient has been charged with a crime, or has been
involuntarily placed for treatment by a court pursuant to s. 394.467 and
continues to meet the criteria for involuntary placement. When transfer to
voluntary status occurs, notice shall be given as provided in s. 394.4599.

(5) TRANSFER TO INVOLUNTARY STATUS. When a voluntary patient, or an
authorized person on the patient's behalf, makes a request for discharge,
the request for discharge, unless freely and voluntarily rescinded, must be
communicated to a physician, clinical psychologist, or psychiatrist as
quickly as possible, but not later than 12 hours after the request is made.
If the patient meets the criteria for involuntary placement, the
administrator of the facility must file with the court a petition for
involuntary placement, within 2 court working days after the request for
discharge is made. If the petition is not filed within 2 court working
days, the patient shall be discharged. Pending the filing of the petition,
the patient may be held and emergency treatment rendered in the least
restrictive manner, upon the written order of a physician, if it is
determined that such treatment is necessary for the safety of the patient
or others. History: s. 8, ch. 71-131; s. 7, ch. 73-133; s. 109, ch. 73-333;
s. 8, ch. 79-298; s. 11, ch. 82-212; s. 709, ch. 95-148; s. 17, ch. 96-169.
Note. Former s. 394.465.

394.463 Involuntary examination. ---

(1) CRITERIA. A person may be taken to a receiving facility for involuntary
examination if there is reason to believe that he or she is mentally ill
and because of his or her mental illness:

(a) 1. The person has refused voluntary examination after conscientious
explanation and disclosure of the purpose of the examination; or 2. The
person is unable to determine for himself or herself whether examination is
necessary; and

(b) 1. Without care or treatment, the person is likely to suffer from
neglect or refuse to care for himself or herself; such neglect or refusal
poses a real and present threat of substantial harm to his or her
well-being; and it is not apparent that such harm may be avoided through
the help of willing family members or friends or the provision of other
services; or 2. There is a substantial likelihood that without care or
treatment the person will cause serious bodily harm to himself or herself
or others in the near future, as evidenced by recent behavior.

(2) INVOLUNTARY EXAMINATION.

(a) An involuntary examination may be initiated by any one of the following
means: 1. A court may enter an ex parte order stating that a person appears
to meet the criteria for involuntary examination, giving the findings on
which that conclusion is based. The ex parte order for involuntary
examination must be based on sworn testimony, written or oral. If other
less restrictive means are not available, such as voluntary appearance for
outpatient evaluation, a law enforcement officer, or other designated agent
of the court, shall take the person into custody and deliver him or her to
the nearest receiving facility for involuntary examination. The order of
the court shall be made a part of the patient's clinical record. No fee
shall be charged for the filing of an order under this subsection. Any
receiving facility accepting the patient based on this order must send a
copy of the order to the Agency for Health Care Administration on the next
working day. The order shall be valid only until executed or, if not
executed, for the period specified in the order itself. If no time limit is
specified in the order, the order shall be valid for 7 days after the date
that the order was signed. 2. A law enforcement officer shall take a person
who appears to meet the criteria for involuntary examination into custody
and deliver the person or have him or her delivered to the nearest
receiving facility for examination. The officer shall execute a written
report detailing the circumstances under which the person was taken into
custody, and the report shall be made a part of the patient's clinical
record. Any receiving facility accepting the patient based on this report
must send a copy of the report to the Agency for Health Care Administration
on the next working day. 3. A physician, clinical psychologist, psychiatric
nurse, or clinical social worker may execute a certificate stating that he
or she has examined a person within the preceding 48 hours and finds that
the person appears to meet the criteria for involuntary examination and
stating the observations upon which that conclusion is based. If other less
restrictive means are not available, such as voluntary appearance for
outpatient evaluation, a law enforcement officer shall take the person
named in the certificate into custody and deliver him or her to the nearest
receiving facility for involuntary examination. The law enforcement officer
shall execute a written report detailing the circumstances under which the
person was taken into custody. The report and certificate shall be made a
part of the patient's clinical record. Any receiving facility accepting the
patient based on this certificate must send a copy of the certificate to
the Agency for Health Care Administration on the next working day.

(b) A person shall not be removed from any program or residential placement
licensed under chapter 400 and transported to a receiving facility for
involuntary examination unless an ex parte order, a professional
certificate, or a law enforcement officer's report is first prepared. If
the condition of the person is such that preparation of a law enforcement
officer's report is not practicable before removal, the report shall be
completed as soon as possible after removal, but in any case before the
person is transported to a receiving facility. A receiving facility
admitting a person for involuntary examination who is not accompanied by
the required ex parte order, professional certificate, or law enforcement
officer's report shall notify the Agency for Health Care Administration of
such admission by certified mail no later than the next working day. The
provisions of this paragraph do not apply when transportation is provided
by the patient's family or guardian.

(c) A law enforcement officer acting in accordance with an ex parte order
issued pursuant to this subsection may serve and execute such order on any
day of the week, at any time of the day or night.

(d) A law enforcement officer acting in accordance with an ex parte order
issued pursuant to this subsection may use such reasonable physical force
as is necessary to gain entry to the premises, and any dwellings,
buildings, or other structures located on the premises, and to take custody
of the person who is the subject of the ex parte order.

(e) The Agency for Health Care Administration shall receive and maintain
the copies of ex parte orders, professional certificates, and law
enforcement officers' reports. These documents shall be considered part of
the clinical record, governed by the provisions of s. 394.4615. The agency
shall prepare annual reports analyzing the data obtained from these
documents, without information identifying patients, and shall provide
copies of reports to the department, the President of the Senate, the
Speaker of the House of Representatives, and the minority leaders of the
Senate and the House of Representatives.

(f) A patient shall be examined by a physician or clinical psychologist at
a receiving facility without unnecessary delay and may, upon the order of a
physician, be given emergency treatment if it is determined that such
treatment is necessary for the safety of the patient or others. The patient
shall not be released by the receiving facility or its contractor without
the documented approval of a psychiatrist or clinical psychologist.
However, a patient may not be held in a receiving facility for involuntary
examination longer than 72 hours.

(g) A person for whom an involuntary examination has been initiated who is
being evaluated or treated at a hospital for an emergency medical condition
specified in s. 395.002 must be examined by a receiving facility within 72
hours. The 72-hour period begins when the patient arrives at the hospital
and ceases when the attending physician documents that the patient has an
emergency medical condition. If the patient is examined at a hospital
providing emergency medical services by a professional qualified to perform
an involuntary examination and is found as a result of that examination not
to meet the criteria for involuntary placement, the patient may be offered
voluntary placement, if appropriate, or released directly from the hospital
providing emergency medical services. The finding by the professional that
the patient has been examined and does not meet the criteria for
involuntary placement must be entered into the patient's clinical record.
Nothing in this paragraph is intended to prevent a hospital providing
emergency medical services from appropriately transferring a patient to
another hospital prior to stabilization, provided the requirements of s.
395.1041(3) (c) have been met.

(h) One of the following must occur within 12 hours after the patient's
attending physician documents that the patient's medical condition has
stabilized or that an emergency medical condition does not exist: 1. The
patient must be examined by a designated receiving facility and released;
or 2. The patient must be transferred to a designated receiving facility in
which appropriate medical treatment is available. However, the receiving
facility must be notified of the transfer within 2 hours after the
patient's condition has been stabilized or after determination that an
emergency medical condition does not exist.

(i) Within the 72-hour examination period or, if the 72 hours ends on a
weekend or holiday, no later than the next working day thereafter, one of
the following actions must be taken, based on the individual needs of the
patient: 1. The patient shall be released, unless he or she is charged with
a crime, in which case the patient shall be returned to the custody of a
law enforcement officer; 2. The patient shall be released, subject to the
provisions of subparagraph 1., for outpatient treatment; 3. The patient,
unless he or she is charged with a crime, shall be asked to give express
and informed consent to placement as a voluntary patient, and, if such
consent is given, the patient shall be admitted as a voluntary patient; or
4. A petition for involuntary placement shall be filed in the appropriate
court by the facility administrator when treatment is deemed necessary; in
which case, the least restrictive treatment consistent with the optimum
improvement of the patient's condition shall be made available.

(3) NOTICE OF RELEASE. Notice of the release shall be given to the
patient's guardian or representative, to any person who executed a
certificate admitting the patient to the receiving facility, and to any
court which ordered the patient's evaluation. History: s. 7, ch. 71-131; s.
6, ch. 73-133; s. 204, ch. 77-147; s. 7, ch. 79-298; s. 10, ch. 82-212; s.
8, ch. 84-285; s. 59, ch. 91-221; s. 3, ch. 91-249; s. 69, ch. 92-289; s.
708, ch. 95-148; s. 16, ch. 96-169.

394.465 Voluntary admissions. ---

Amended and transferred to s. 394.4625 by s. 17, ch. 96-169.

394.467 Involuntary placement. ---

(1) CRITERIA. A person may be involuntarily placed for treatment upon a
finding of the court by clear and convincing evidence that:

(a) He or she is mentally ill and because of his or her mental illness: 1.
a. He or she has refused voluntary placement for treatment after sufficient
and conscientious explanation and disclosure of the purpose of placement
for treatment; or b. He or she is unable to determine for himself or
herself whether placement is necessary; and 2. a. He or she is manifestly
incapable of surviving alone or with the help of willing and responsible
family or friends, including available alternative services, and, without
treatment, is likely to suffer from neglect or refuse to care for himself
or herself, and such neglect or refusal poses a real and present threat of
substantial harm to his or her well-being; or b. There is substantial
likelihood that in the near future he or she will inflict serious bodily
harm on himself or herself or another person, as evidenced by recent
behavior causing, attempting, or threatening such harm; and

(b) All available less restrictive treatment alternatives which would offer
an opportunity for improvement of his or her condition have been judged to
be inappropriate.

(2) ADMISSION TO A TREATMENT FACILITY. A patient may be retained by a
receiving facility or involuntarily placed in a treatment facility upon the
recommendation of the administrator of a receiving facility where the
patient has been examined and after adherence to the notice and hearing
procedures provided in s. 394.4599. The recommendation must be supported by
the opinion of a psychiatrist and the second opinion of a clinical
psychologist or another psychiatrist, both of whom have personally examined
the patient within the preceding 72 hours, that the criteria for
involuntary placement are met. However, in counties of less than 50,000
population, if the administrator certifies that no psychiatrist or clinical
psychologist is available to provide the second opinion, such second
opinion may be provided by a licensed physician with postgraduate training
and experience in diagnosis and treatment of mental and nervous disorders
or by a psychiatric nurse. Such recommendation shall be entered on an
involuntary placement certificate, which certificate shall authorize the
receiving facility to retain the patient pending transfer to a treatment
facility or completion of a hearing.

(3) PETITION FOR INVOLUNTARY PLACEMENT. The administrator of the facility
shall file a petition for involuntary placement in the court in the county
where the patient is located. Upon filing, the clerk of the court shall
provide copies to the department, the patient, the patient's guardian or
representative, and the state attorney and public defender of the judicial
circuit in which the patient is located. No fee shall be charged for the
filing of a petition under this subsection.

(4) APPOINTMENT OF COUNSEL. Within 1 court working day after the filing of
a petition for involuntary placement, the court shall appoint the public
defender to represent the person who is the subject of the petition, unless
the person is otherwise represented by counsel. The clerk of the court
shall immediately notify the public defender of such appointment. Any
attorney representing the patient shall have access to the patient,
witnesses, and records relevant to the presentation of the patient's case
and shall represent the interests of the patient, regardless of the source
of payment to the attorney.

(5) CONTINUANCE OF HEARING. The patient is entitled, with the concurrence
of the patient's counsel, to at least one continuance of the hearing. The
continuance shall be for a period of up to 4 weeks.

(6) HEARING ON INVOLUNTARY PLACEMENT.

(a) 1. The court shall hold the hearing on involuntary placement within 5
days, unless a continuance is granted. The hearing shall be held in the
county where the patient is located and shall be as convenient to the
patient as may be consistent with orderly procedure and shall be conducted
in physical settings not likely to be injurious to the patient's condition.
If the court finds that the patient's attendance at the hearing is not
consistent with the best interests of the patient, and the patient's
counsel does not object, the court may waive the presence of the patient
from all or any portion of the hearing. The state attorney for the circuit
in which the patient is located shall represent the state, rather than the
petitioning facility administrator, as the real party in interest in the
proceeding. 2. The court may appoint a master to preside at the hearing.
One of the professionals who executed the involuntary placement certificate
shall be a witness. The patient and the patient's guardian or
representative shall be informed by the court of the right to an
independent expert examination. If the patient cannot afford such an
examination, the court shall provide for one. The independent expert's
report shall be confidential and not discoverable, unless the expert is to
be called as a witness for the patient at the hearing. The testimony in the
hearing must be given under oath, and the proceedings must be recorded. The
patient may refuse to testify at the hearing.

(b) If the court concludes that the patient meets the criteria for
involuntary placement, it shall order that the patient be transferred to a
treatment facility or, if the patient is at a treatment facility, that the
patient be retained there or be treated at any other appropriate receiving
or treatment facility, or that the patient receive services from a
receiving or treatment facility, on an involuntary basis, for a period of
up to 6 months. The order shall specify the nature and extent of the
patient's mental illness. The facility shall discharge a patient any time
the patient no longer meets the criteria for involuntary placement, unless
the patient has transferred to voluntary status.

(c) If at any time prior to the conclusion of the hearing on involuntary
placement it appears to the court that the person does not meet the
criteria for involuntary placement under this chapter, but instead meets
the criteria for involuntary assessment, protective custody, or involuntary
admission pursuant to s. 397.675, then the court may order the person to be
admitted for involuntary assessment for a period of 5 days pursuant to s.
397.6811. Thereafter, all proceedings shall be governed by chapter 397.

(d) At the hearing on involuntary placement, the court shall consider
testimony and evidence regarding the patient's competence to consent to
treatment. If the court finds that the patient is incompetent to consent to
treatment, it shall appoint a guardian advocate as provided in s. 394.4598.

(e) The administrator of the receiving facility shall provide a copy of the
court order and adequate documentation of a patient's mental illness to the
administrator of a treatment facility whenever a patient is ordered for
involuntary placement, whether by civil or criminal court. Such
documentation shall include any advance directives made by the patient, a
psychiatric evaluation of the patient, and any evaluations of the patient
performed by a clinical psychologist or a clinical social worker. The
administrator of a treatment facility may refuse admission to any patient
directed to its facilities on an involuntary basis, whether by civil or
criminal court order, who is not accompanied at the same time by adequate
orders and documentation.

(7) PROCEDURE FOR CONTINUED INVOLUNTARY PLACEMENT.

(a) Hearings on petitions for continued involuntary placement shall be
administrative hearings and shall be conducted in accordance with the
provisions of s. 120.57(1), except that any order entered by the hearing
officer shall be final and subject to judicial review in accordance with s.
120.68. Orders concerning patients committed after successfully pleading
not guilty by reason of insanity shall be governed by the provisions of s.
916.15.

[Footnote 1] (b) If the patient continues to meet the criteria for
involuntary placement, the administrator shall, prior to the expiration of
the period during which the treatment facility is authorized to retain the
patient, file a petition requesting authorization for continued involuntary
placement. The request shall be accompanied by a statement from the
patient's physician or clinical psychologist justifying the request, a
brief description of the patient's treatment during the time he or she was
involuntarily placed, and an individualized plan of continued treatment.
Notice of the hearing shall be provided as set forth in s. 394.4599. If at
the hearing the hearing officer finds that attendance at the hearing is not
consistent with the best interests of the patient, the hearing officer may
waive the presence of the patient from all or any portion of the hearing,
unless the patient, through counsel, objects to the waiver of presence. The
testimony in the hearing must be under oath, and the proceedings must be
recorded.

(c) Unless the patient is otherwise represented or is ineligible, he or she
shall be represented at the hearing on the petition for continued
involuntary placement by the public defender of the circuit in which the
facility is located.

(d) If at a hearing it is shown that the patient continues to meet the
criteria for involuntary placement, the administrative law judge shall sign
the order for continued involuntary placement for a period not to exceed 6
months. The same procedure shall be repeated prior to the expiration of
each additional period the patient is retained.

(e) If continued involuntary placement is necessary for a patient admitted
while serving a criminal sentence, but whose sentence is about to expire,
or for a patient involuntarily placed while a minor but who is about to
reach the age of 18, the administrator shall petition the administrative
law judge for an order authorizing continued involuntary placement.

[Footnote 2] (f) If the patient has been previously found incompetent to
consent to treatment, the hearing officer shall consider testimony and
evidence regarding the patient's competence. If the hearing officer finds
evidence that the patient is now competent to consent to treatment, the
hearing officer may issue a recommended order to the court that found the
patient incompetent to consent to treatment that the patient's competence
be restored and that any guardian advocate previously appointed be
discharged.

(8) RETURN OF PATIENTS. When a patient at a treatment facility leaves the
facility without authorization, the administrator may authorize a search
for the patient and the return of the patient to the facility. The
administrator may request the assistance of a law enforcement agency in the
search for and return of the patient. History: s. 9, ch. 71-131; s. 8, ch.
73-133; ss. 3, 4, ch. 74-233; s. 1, ch. 75-305; s. 17, ch. 77-121; s. 205,
ch. 77-147; s. 1, ch. 77-174; ss. 2, 8, ch. 77-312; s. 19, ch. 78-95; s. 1,
ch. 78-197; s. 9, ch. 79-298; s. 2, ch. 79-336; ss. 2, 4, ch. 80-75; s. 12,
ch. 82-212; s. 9, ch. 84-285; s. 28, ch. 85-167; s. 105, ch. 89-96; s. 70,
ch. 90-271; s. 710, ch. 95-148; s. 18, ch. 96-169; s. 124, ch. 96-410.
[Footnote 1] Note. Redesignated as paragraph (7) (b) and amended by s. 18,
ch. 96-169. This version is published as the last expression of legislative
will ( see Journal of the House of Representatives 1996, pp. 2168 and
2374). Paragraph (4) (a) was also amended by s. 124, ch. 96-410, and that
version of paragraph (4) (a), redesignated as paragraph (7) (b), reads: (7)
PROCEDURE FOR CONTINUED INVOLUNTARY PLACEMENT. (b) If continued placement
of an involuntary patient is necessary, the administrator shall, prior to
the expiration of the period during which the treatment facility is
authorized to retain the patient, request an order authorizing continued
involuntary placement. This request shall be accompanied by a statement
from the patient's physician or clinical psychologist justifying the
request and a brief summary of the patient's treatment during the time he
or she was involuntarily placed. In addition, the administrator shall
submit an individualized plan for the patient for whom he or she is
requesting continued involuntary placement. Notification of this request
for retention shall be mailed to the patient and his or her guardian or
representative along with a completed petition, requiring only a signature,
for a hearing regarding the continued hospitalization and a
waiver-of-hearing form. The waiver-of-hearing form shall require express
and informed consent and shall state that the patient is entitled to a
hearing under the law; that he or she is entitled to be represented by an
attorney at the hearing and, if he or she cannot afford an attorney, that
one will be appointed; and that, if it is shown at the hearing that the
patient does not meet the criteria for involuntary placement, he or she is
entitled to be released. In a proceeding involving a person 18 years of age
or older, the hearing may be waived by express and informed consent in
writing by the patient after the advice of counsel. If the patient or his
or her guardian or representative does not sign the petition, or if the
patient does not sign a waiver within 15 days, the administrative law judge
shall notice a hearing with regard to the patient involved in accordance
with ss. 120.569 and 120.57(1). In a proceeding involving a person under
the age of 18, the hearing shall not be waived; however, if, at the
hearing, the administrative law judge finds that attendance at the hearing
is not consistent with the best interests of the patient, he or she may
waive the presence of the patient from all or any portion of the hearing.
[Footnote 2] Note. Redesignated as paragraph (7) (f) and amended by s. 18,
ch. 96-169. This version is published as the last expression of legislative
will ( see Journal of the House of Representatives 1996, pp. 2168 and
2374). Paragraph (4) (h) was also amended by s. 124, ch. 96-410, and that
version of paragraph (4) (h), redesignated as paragraph (7) (f), reads: (f)
At any hearing hereunder for a patient who has been previously adjudicated
incompetent to consent to treatment, the administrative law judge shall
consider testimony and evidence regarding the patient's competence. If the
administrative law judge finds evidence that the patient is competent to
consent to treatment, he or she may issue to the court in which the patient
was adjudicated incompetent to consent to treatment a recommended order
that the patient's competence be restored and that any guardian advocate
previously appointed be discharged.

394.4672 Procedure for placement of veteran with federal agency. ---

(1) Whenever it is determined by the court that a person meets the criteria
for involuntary placement and it appears that such person is eligible for
care or treatment by the United States Department of Veterans Affairs or
other agency of the United States Government, the court, upon receipt of a
certificate from the United States Department of Veterans Affairs or such
other agency showing that facilities are available and that the person is
eligible for care or treatment therein, may place that person with the
United States Department of Veterans Affairs or other federal agency. The
person whose placement is sought shall be personally served with notice of
the pending placement proceeding in the manner as provided in this part,
and nothing in this section shall affect his or her right to appear and be
heard in the proceeding. Upon placement, the person shall be subject to the
rules and regulations of the United States Department of Veterans Affairs
or other federal agency.

(2) The judgment or order of placement by a court of competent jurisdiction
of another state or of the District of Columbia, placing a person with the
United States Department of Veterans Affairs or other federal agency for
care or treatment, shall have the same force and effect in this state as in
the jurisdiction of the court entering the judgment or making the order;
and the courts of the placing state or of the District of Columbia shall be
deemed to have retained jurisdiction of the person so placed. Consent is
hereby given to the application of the law of the placing state or district
with respect to the authority of the chief officer of any facility of the
United States Department of Veterans Affairs or other federal agency
operated in this state to retain custody or to transfer, parole, or
discharge the person.

(3) Upon receipt of a certificate of the United States Department of
Veterans Affairs or such other federal agency that facilities are available
for the care or treatment of mentally ill persons and that the person is
eligible for care or treatment, the administrator of the receiving or
treatment facility may cause the transfer of that person to the United
States Department of Veterans Affairs or other federal agency. Upon
effecting such transfer, the committing court shall be notified by the
transferring agency. No person shall be transferred to the United States
Department of Veterans Affairs or other federal agency if he or she is
confined pursuant to the conviction of any felony or misdemeanor or if he
or she has been acquitted of the charge solely on the ground of insanity,
unless prior to transfer the court placing such person enters an order for
the transfer after appropriate motion and hearing and without objection by
the United States Department of Veterans Affairs.

(4) Any person transferred as provided in this section shall be deemed to
be placed with the United States Department of Veterans Affairs or other
federal agency pursuant to the original placement. History: s. 15, ch.
14579, 1929; CGL 1936 Supp. 2146(16); s. 1, ch. 21795, 1943; s. 4, ch.
84-62; s. 18, ch. 93-268; s. 711, ch. 95-148; s. 19, ch. 96-169. Note.
Former s. 293.16.

394.4674 Plan and report. ---

(1) The department is directed to develop a comprehensive plan for the
deinstitutionalization of patients in a treatment facility who are over age
55 and do not meet the criteria for involuntary placement pursuant to s.
394.467. The plan shall include, but need not be limited to, the projected
numbers of patients, the timetables for deinstitutionalization, and the
specific actions to be taken to accomplish the deinstitutionalization.

(2) The department shall prepare and submit a semiannual report to the
Legislature, until the conditions specified in subsection (1) are met,
which shall include, but not be limited to:

(a) The status of compliance with the deinstitutionalization plan;

(b) The specific efforts to stimulate alternative living and support
resources outside the hospitals and all documentation of the success of
these efforts;

(c) The specific efforts to facilitate the development and retention of
daily living skills identified by the department as being necessary for
living outside an institution and any evidence of the success of these
efforts;

(d) The specific plans for new efforts to accomplish the
deinstitutionalization of patients in this age group; and

(e) Any evidence of involvement between the Alcohol, Drug Abuse, and Mental
Health Program Office and other program offices within the department and
between the department and other state and private agencies and individuals
to accomplish the deinstitutionalization of patients in this age group.
History: s. 2, ch. 80-293; s. 245, ch. 81-259; s. 6, ch. 81-290; s. 20, ch.
96-169.

394.468 Admission and discharge procedures. ---

Admission and discharge procedures and treatment policies of the department
are governed solely by this part. Such procedures and policies shall not be
subject to control by court procedure rules. The matters within the purview
of this part are deemed to be substantive, not procedural. History: s. 9,
ch. 77-312; s. 21, ch. 96-169.

394.4685 Transfer of patients among facilities. ---

(1) TRANSFER BETWEEN PUBLIC FACILITIES.

(a) A patient who has been admitted to a public receiving facility, or the
family member, guardian, or guardian advocate of such patient, may request
the transfer of the patient to another public receiving facility. A patient
who has been admitted to a public treatment facility, or the family member,
guardian, or guardian advocate of such patient, may request the transfer of
the patient to another public treatment facility. Depending on the medical
treatment or mental health treatment needs of the patient and the
availability of appropriate facility resources, the patient may be
transferred at the discretion of the department. If the department approves
the transfer of an involuntary patient, notice according to the provisions
of s. 394.4599 shall be given prior to the transfer by the transferring
facility. The department shall respond to the request for transfer within 2
working days after receipt of the request by the facility administrator.

(b) When required by the medical treatment or mental health treatment needs
of the patient or the efficient utilization of a public receiving or public
treatment facility, a patient may be transferred from one receiving
facility to another, or one treatment facility to another, at the
department's discretion, or, with the express and informed consent of the
patient or the patient's guardian or guardian advocate, to a facility in
another state. Notice according to the provisions of s. 394.4599 shall be
given prior to the transfer by the transferring facility. If prior notice
is not possible, notice of the transfer shall be provided as soon as
practicable after the transfer.

(2) TRANSFER FROM PUBLIC TO PRIVATE FACILITIES. A patient who has been
admitted to a public receiving or public treatment facility and has
requested, either personally or through his or her guardian or guardian
advocate, and is able to pay for treatment in a private facility shall be
transferred at the patient's expense to a private facility upon acceptance
of the patient by the private facility.

(3) TRANSFER FROM PRIVATE TO PUBLIC FACILITIES.

(a) A patient or the patient's guardian or guardian advocate may request
the transfer of the patient from a private to a public facility, and the
patient may be so transferred upon acceptance of the patient by the public
facility.

(b) A private facility may request the transfer of a patient from the
facility to a public facility, and the patient may be so transferred upon
acceptance of the patient by the public facility. The cost of such transfer
shall be the responsibility of the transferring facility.

(c) A public facility must respond to a request for the transfer of a
patient within 2 working days after receipt of the request.

(4) TRANSFER BETWEEN PRIVATE FACILITIES. A patient in a private facility or
the patient's guardian or guardian advocate may request the transfer of the
patient to another private facility at any time, and the patient shall be
transferred upon acceptance of the patient by the facility to which
transfer is sought. History: s. 22, ch. 96-169.

394.469 Discharge of involuntary patients. ---

(1) POWER TO DISCHARGE. At any time a patient is found to no longer meet
the criteria for involuntary placement, the administrator shall:

(a) Discharge the patient, unless the patient is under a criminal charge,
in which case the patient shall be transferred to the custody of the
appropriate law enforcement officer;

(b) Transfer the patient to voluntary status on his or her own authority or
at the patient's request, unless the patient is under criminal charge or
adjudicated incapacitated; or

(c) Place an improved patient, except a patient under a criminal charge, on
convalescent status in the care of a community facility.

(2) NOTICE. Notice of discharge or transfer of a patient shall be given as
provided in s. 394.4599. History: s. 10, ch. 71-131; s. 9, ch. 73-133; s.
10, ch. 79-298; s. 13, ch. 82-212; s. 712, ch. 95-148; s. 23, ch. 96-169.

394.471 Validity of prior involuntary placement orders. ---

Repealed by s. 54, ch. 96-169.

394.475 Acceptance, examination, and involuntary placement of Florida
residents from out-of-state mental health authorities. ---

(1) Upon the request of the state mental health authority of another state,
the department is authorized to accept as a patient, for a period of not
more than 15 days, a person who is and has been a bona fide resident of
this state for a period of not less than 1 year.

(2) Any person received pursuant to subsection (1) shall be examined by the
staff of the state facility where such patient has been accepted, which
examination shall be completed during the 15-day period.

(3) If upon examination such a person requires continued involuntary
placement, a petition for a hearing regarding involuntary placement shall
be filed with the court of the county wherein the treatment facility
receiving the patient is located or the county where the patient is a
resident.

(4) During the pendency of the examination period and the pendency of the
involuntary placement proceedings, such person may continue to be held in
the treatment facility unless the court having jurisdiction enters an order
to the contrary. History: s. 14, ch. 71-131; s. 25, ch. 73-334; s. 206, ch.
77-147; s. 13, ch. 79-298; s. 15, ch. 82-212; s. 24, ch. 96-169.

394.477 Residence requirements. ---

Repealed by s. 54, ch. 96-169.

394.478 Autopsy of deceased patient. ---

Repealed by s. 54, ch. 96-169.

394.4786 Intent. ---

(1) The Legislature intends that all hospitals, excluding hospitals owned
and operated by the department or the Department of Corrections, be
assessed on a continuing basis an amount equal to 1.5 percent of the
hospital's annual net operating revenues and that the assessments be
deposited into the Public Medical Assistance Trust Fund.

(2) Further, the Legislature intends that a specialty psychiatric hospital
that provides health care to specified indigent patients be eligible for
reimbursement up to the amount that hospital contributed to the Public
Medical Assistance Trust Fund in the previous fiscal year. History: s. 1,
ch. 89-355; s. 25, ch. 96-169.

394.4787 Definitions. ---

As used in this section and ss. 394.4786, 394.4788, and 394.4789:

(1) "Acute mental health services" means mental health services provided
through inpatient hospitalization.

(2) "Agency" means the Agency for Health Care Administration.

(3) "Charity care" means that portion of hospital charges for care provided
to a patient whose family income for the 12 months preceding the
determination is equal to or below 150 percent of the current federal
nonfarm poverty guideline or the amount of hospital charges due from the
patient which exceeds 25 percent of the annual family income and for which
there is no compensation. Charity care shall not include administrative or
courtesy discounts, contractual allowances to third party payors, or
failure of a hospital to collect full charges due to partial payment by
governmental programs.

(4) "Indigent" means an individual whose financial status would qualify him
or her for charity care.

(5) "Operating expense" means all common and accepted costs appropriate in
developing and maintaining the operating of the patient care facility and
its activities.

(6) "PMATF" means the Public Medical Assistance Trust Fund.

(7) "Specialty psychiatric hospital" means a hospital licensed by the
agency pursuant to s. 395.002(27) as a specialty psychiatric hospital.
History: s. 2, ch. 89-355; s. 1, ch. 90-192; s. 11, ch. 90-295; s. 55, ch.
91-282; s. 90, ch. 92-33; ss. 70, 98, ch. 92-289; s. 717, ch. 95-148; s.
26, ch. 96-169.

394.4788 Use of certain PMATF funds for the purchase of acute care mental
health services. ---

(1) A hospital may be eligible to be reimbursed an amount no greater than
the hospital's previous year contribution to the PMATF for acute mental
health services provided to indigent mentally ill persons who have been
determined by the agency or its agent to require such treatment and who:

(a) Do not meet Medicaid eligibility criteria, unless the agency makes a
referral for a Medicaid eligible patient pursuant to s. 394.4789;

(b) Meet the criteria for mental illness under this part; and

(c) Meet the definition of charity care.

(2) By October 1, 1989, and annually thereafter, the agency shall calculate
a per diem reimbursement rate for each specialty psychiatric hospital to be
paid to the specialty psychiatric hospitals for the provision of acute
mental health services provided to indigent mentally ill patients who meet
the criteria in subsection (1). After the first rate period, providers
shall be notified of new reimbursement rates for each new state fiscal year
by June 1. The new reimbursement rates shall commence July 1.

(3) Reimbursement rates shall be calculated using the most recent audited
actual costs received by the agency. Cost data received as of August 15,
1989, and each April 15 thereafter shall be used in the calculation of the
rates. Historic costs shall be inflated from the midpoint of a hospital's
fiscal year to the midpoint of the state fiscal year. The inflation
adjustment shall be made utilizing the latest available projections as of
March 31 for the Data Resources Incorporated National and Regional Hospital
Input Price Indices as calculated by the Medicaid program office.

(4) Reimbursement shall be based on compensating a specialty psychiatric
hospital at a per diem rate equal to its operating costs per inpatient day.

(5) A hospital shall not be entitled to receive more in any one fiscal year
than that hospital contributed to the PMATF during the previous fiscal
year.

(6) Hospitals that agree to participate in the program set forth in this
section and ss. 394.4786, 394.4787, and 394.4789 shall agree that payment
from the PMATF is payment in full for all patients for which reimbursement
is received under this section and ss. 394.4786, 394.4787, and 394.4789,
until the funds for this program are no longer available.

(7) The agency shall develop a payment system to reimburse specialty
psychiatric hospitals quarterly as set forth in this part. History: s. 3,
ch. 89-355; s. 1, ch. 90-192; s. 98, ch. 92-289; s. 27, ch. 96-169. PART IV
COMMUNITY ALCOHOL, DRUG ABUSE, AND MENTAL HEALTH SERVICES

394.90 Inspection; right of entry; records. ---

(1)

(a) The department may enter and inspect at any time a licensed facility to
determine whether the facility is in compliance with this chapter and the
rules of the department.

(b) The department may enter and inspect any premises that it has probable
cause to suspect may be operating as an unlicensed crisis stabilization
unit or residential treatment facility; however, such entry and inspection
shall be made only with the permission of the person in charge of such
premises or pursuant to warrant.

(c) Any application for licensure under this chapter constitutes full
permission for the department to enter and inspect the premises of the
applicant or licensee at any time.

(2) For purposes of monitoring and investigation, the department and the
Agency for Health Care Administration shall have access to the clinical
records of any client of a licensee or designated facility, the provisions
of s. 394.4615 to the contrary notwithstanding.

(3) The department shall schedule periodic inspections of licensees so as
to minimize the cost to the licensees and the disruption of the licensees'
programs. This subsection shall not be construed to limit the authority of
the department to inspect the facilities of a licensee at any time.

(4) Each licensee shall maintain as public information, available to any
person upon request, copies of all reports of inspections of the licensee
filed with or issued by any governmental agency during the preceding 5-year
period. The licensee shall furnish a copy of the most recent inspection
report of the department to any person upon payment of a reasonable charge
for copying.

(5)

(a) The department may accept, in lieu of its own inspections for
licensure, the survey or inspection of an accrediting organization, if the
provider is accredited and the department receives the report of the
accrediting organization. The department shall develop, and adopt by rule,
specific criteria for assuring that the accrediting organization has
specific standards and experience related to the program area being
licensed, specific criteria for accepting the standards and survey
methodologies of an accrediting organization, delineations of the
obligations of accrediting organizations to assure adherence to those
standards, criteria for receiving, accepting and maintaining the
confidentiality of the survey and corrective action reports, and allowance
for the department's participation in surveys.

(b) The department shall conduct [Footnote 1] compliance investigations and
sample validation inspections to evaluate the inspection process of
accrediting organizations to ensure minimum standards are maintained as
provided in Florida Statute and rule. The department may conduct a
lifesafety inspection in calendar years in which an accrediting
organization survey is not conducted and shall conduct a full state
inspection, including a lifesafety inspection, if an accrediting
organization survey has not been conducted within the previous 36 months.
The department, by accepting the survey or inspection of an accrediting
organization, does not forfeit its right to perform inspections. History:
ss. 7, 11, ch. 85-167; s. 4, ch. 91-429; s. 47, ch. 93-39; s. 28, ch.
96-169. [Footnote 1] Note. The word "compliance" was substituted by the
editors for the word "compliant."

394.907 Community mental health centers; quality assurance programs. ---

(1) As used in this section, "community mental health center" means a
publicly funded, not-for-profit center which contracts with the department
for the provision of inpatient, outpatient, day treatment, or emergency
services.

(2) Effective April 1, 1989, any community mental health center and any
facility licensed pursuant to s. 394.875 shall have an ongoing quality
assurance program. The purpose of the quality assurance program shall be to
objectively and systematically monitor and evaluate the appropriateness and
quality of client care, to ensure that services are rendered consistent
with reasonable, prevailing professional standards and to resolve
identified problems.

(3) Each facility shall develop a written plan which addresses the minimum
guidelines for the quality assurance program. Such guidelines shall
include, but are not limited to:

(a) Standards for the provision of client care and treatment practices;

(b) Procedures for the maintenance of client records;

(c) Policies and procedures for staff development;

(d) Standards for facility safety and maintenance;

(e) Procedures for peer review and resource utilization;

(f) Policies and procedures for adverse incident reporting to include
verification of corrective action to remediate or minimize incidents and
for reporting such incidents to the department by a timeframe as prescribed
by rule. Such plan shall be submitted to the governing board for approval
and a copy provided to the department.

(4) The quality assurance program shall be directly responsible to the
executive director of the facility and shall be subject to review by the
governing board of the agency.

(5) Each facility shall designate a quality assurance manager who is an
employee of the agency or under contract with the agency.

(6) Incident reporting shall be the affirmative duty of all staff. Any
person filing an incident report shall not be subject to any civil action
by virtue of such incident report.

(7) The department shall have access to all records necessary to determine
agency compliance with the provisions of this section. The records of
quality assurance programs which relate solely to actions taken in carrying
out the provisions of this section, and records obtained by the department
to determine agency compliance with the provisions of this section, are
confidential and exempt from the provisions of s. 119.07(1). Such records
are not admissible in any civil or administrative action, except in
disciplinary proceedings by the Department of Business and Professional
Regulation and the appropriate regulatory board, nor shall such records be
available to the public as part of the record of investigation for, and
prosecution in disciplinary proceedings made available to the public by the
Department of Business and Professional Regulation or the appropriate
regulatory board. Meetings or portions of meetings of quality assurance
program committees that relate solely to actions taken pursuant to this
section are exempt from the provisions of s. 286.011.

(8) The department shall promulgate rules to carry out the provisions of
this section.

(9) The provisions of this section shall not apply to hospitals licensed
pursuant to chapter 395 or programs operated within such hospitals.
History: ss. 22, 26, ch. 88-398; s. 22, ch. 90-347; s. 4, ch. 91-429; s.
43, ch. 94-218; s. 211, ch. 96-406.
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