HOUSE AMENDMENT Bill No. CS/SB 2404
1	CHAMBER ACTION
2	Senate House
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12	Representative(s) Simmons offered the following:
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14	Amendment (with title amendments)
15	On page 33, between line(s) 27 and 28,
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17	insert:
18	Section 11. Subsection (3) of section 394.455, Florida
19	Statutes, is amended, and subsections (31) and (32) are added to
20	said section, to read:
21	394.455 Definitions.--As used in this part, unless the
22	context clearly requires otherwise, the term:
23	(3) "Clinical record" means all parts of the record
24	required to be maintained and includes all medical records,
25	progress notes, charts, and admission and discharge data, and
26	all other information recorded by a facility which pertains to
27	the patient's hospitalization orandtreatment.
28	(31) "Service provider” means any public or private
29	receiving facility, entity under contract with the Department of
30	Children and Family Services to provide mental health services,
31	or a clinical psychologist, clinical social worker, physician,
32	psychiatric nurse, community mental health center, or clinic as
33	defined in this part.
34	(32) "Involuntary placement” means involuntary outpatient
35	treatment pursuant to s. 394.466 or involuntary inpatient
36	treatment pursuant to s. 394.467.
37	Section 12. Subsections (1) and (7) of section 394.4598,
38	Florida Statutes, are amended to read:
39	394.4598 Guardian advocate.--
40	(1) The administrator may petition the court for the
41	appointment of a guardian advocate based upon the opinion of a
42	psychiatrist that the patient is incompetent to consent to
43	treatment. If the court finds that a patient is incompetent to
44	consent to treatment and has not been adjudicated incapacitated
45	and a guardian with the authority to consent to mental health
46	treatment appointed, it shall appoint a guardian advocate. The
47	patient has the right to have an attorney represent him or her
48	at the hearing. If the person is indigent, the court shall
49	appoint the office of the public defender to represent him or
50	her at the hearing. The patient has the right to testify, cross-
51	examine witnesses, and present witnesses. The proceeding shall
52	be recorded either electronically or stenographically, and
53	testimony shall be provided under oath. One of the professionals
54	authorized to give an opinion in support of a petition for
55	involuntary placement, as described in s. 394.466 ors.
56	394.467(2), must testify. A guardian advocate must meet the
57	qualifications of a guardian contained in part IV of chapter
58	744, except that a professional referred to in this part, an
59	employee of the facility providing direct services to the
60	patient under this part, a departmental employee, a facility
61	administrator, or member of the Florida local advocacy council
62	shall not be appointed. A person who is appointed as a guardian
63	advocate must agree to the appointment.
64	(7) The guardian advocate shall be discharged when the
65	patient is discharged from an order for involuntary inpatient or
66	outpatient placement or as provided in s. 394.466(6)(d)a
67	receiving or treatment facility to the communityor when the
68	patient is transferred from involuntary to voluntary status. The
69	court or a hearing officer shall consider the competence of the
70	patient pursuant to subsection (1) and may consider an
71	involuntarily placed patient's competence to consent to
72	treatment at any hearing. Upon sufficient evidence, the court
73	may restore, or the hearing officer may recommend that the court
74	restore, the patient's competence. A copy of the order restoring
75	competence or the certificate of discharge containing the
76	restoration of competence shall be provided to the patient and
77	the guardian advocate.
78	Section 13. Paragraph (c) is added to subsection (3) of
79	section 394.4615, Florida Statutes, to read:
80	394.4615 Clinical records; confidentiality.--
81	(3) Information from the clinical record may be released
82	when:
83	(c) It is necessary to determine whether a person meets
84	the criteria for involuntary outpatient placement pursuant to s.
85	394.466. In such circumstance, the clinical record may be
86	released to the state attorney, public defender or the patient’s
87	private legal counsel, the court, and the appropriate mental
88	health professionals.
89	Section 14. Subsection (1) and paragraphs (e), (g), and
90	(i) of subsection (2) of section 394.463, Florida Statutes, are
91	amended to read:
92	394.463 Involuntary examination.--
93	(1) CRITERIA.--A person may be taken to a receiving
94	facility for involuntary examination if there is reason to
95	believe that the person has a mental illnesshe or she is
96	mentally illand because of his or her mental illness:
97	(a)1. The person has refused voluntary examination after
98	conscientious explanation and disclosure of the purpose of the
99	examination; or
100	2. The person is unable to determine for himself or
101	herself whether examination is necessary; and
102	(b) Based on the person’s current reported or observed
103	behavior, considering any mental health history, there is a
104	substantial likelihood that, without care or treatment:
105	1. Without care or treatment, The person willis likely to
106	suffer from neglect or refuse to care for himself or herself;
107	such neglect or refusal will poseposesa real and present
108	threat of substantial harm to his or her well-being; and it is
109	not apparent that such harm may be avoided through the help of
110	willing family members or friends or the provision of other
111	services; or
112	2. There is a substantial likelihood that without care or
113	treatmentThe person will cause serious bodily harm to himself
114	or herself or others in the near future, as evidenced by recent
115	behavior.
116	(2) INVOLUNTARY EXAMINATION.--
117	(e) The Agency for Health Care Administration shall
118	receive and maintain the copies of ex parte orders, involuntary
119	outpatient placement orders issued pursuant to s. 394.466, or
120	involuntary inpatient placement orders issued pursuant to s.
121	394.467,professional certificates, and law enforcement
122	officers' reports. These documents shall be considered part of
123	the clinical record, governed by the provisions of s. 394.4615.
124	The agency shall prepare annual reports analyzing the data
125	obtained from these documents, without information identifying
126	patients, and shall provide copies of reports to the department,
127	the President of the Senate, the Speaker of the House of
128	Representatives, and the minority leaders of the Senate and the
129	House of Representatives.
130	(g) A person for whom an involuntary examination has been
131	initiated who is being evaluated or treated at a hospital for an
132	emergency medical condition specified in s. 395.002 must be
133	examined by a receiving facility within 72 hours. The 72-hour
134	period begins when the patient arrives at the hospital and
135	ceases when the attending physician documents that the patient
136	has an emergency medical condition. If the patient is examined
137	at a hospital providing emergency medical services by a
138	professional qualified to perform an involuntary examination and
139	is found as a result of that examination not to meet the
140	criteria for involuntary outpatient placement pursuant to s.
141	394.466(1) or involuntary inpatient placement pursuant to s.
142	394.467(1), the patient may be offered voluntary placement, if
143	appropriate, or released directly from the hospital providing
144	emergency medical services. The finding by the professional that
145	the patient has been examined and does not meet the criteria for
146	involuntary inpatient placement or involuntary outpatient
147	placement must be entered into the patient's clinical record.
148	Nothing in this paragraph is intended to prevent a hospital
149	providing emergency medical services from appropriately
150	transferring a patient to another hospital prior to
151	stabilization, provided the requirements of s. 395.1041(3)(c)
152	have been met.
153	(i) Within the 72-hour examination period or, if the 72
154	hours ends on a weekend or holiday, no later than the next
155	working day thereafter, one of the following actions must be
156	taken, based on the individual needs of the patient:
157	1. The patient shall be released, unless he or she is
158	charged with a crime, in which case the patient shall be
159	returned to the custody of a law enforcement officer;
160	2. The patient shall be released, subject to the
161	provisions of subparagraph 1., for voluntaryoutpatient
162	treatment;
163	3. The patient, unless he or she is charged with a crime,
164	shall be asked to give express and informed consent to placement
165	as a voluntary patient, and, if such consent is given, the
166	patient shall be admitted as a voluntary patient; or
167	4. A petition for involuntary inpatient placement or a
168	petition for involuntary outpatientplacement shall be filed in
169	the appropriate court by the petitioner delineated in s.
170	394.466(3)(a)facility administratorwhen treatment is deemed
171	necessary; in which case, the least restrictive treatment
172	consistent with the optimum improvement of the patient's
173	condition shall be made available.
174	Section 15. Section 394.466, Florida Statutes, is created
175	to read:
176	394.466 Involuntary outpatient placement.--
177	(1) CRITERIA FOR INVOLUNTARY OUTPATIENT PLACEMENT.--
178	(a) A person may be ordered to involuntary outpatient
179	placement upon a finding of the court that, by clear and
180	convincing evidence:
181	1. The person is 18 years of age or older.
182	2. The person has a mental illness.
183	3. The person is unlikely to survive safely in the
184	community without supervision, based on a clinical
185	determination.
186	4. The person has a history of lack of compliance with
187	treatment for mental illness.
188	5. The person has:
189	a. At least twice within the last 36 months, been admitted
190	for examination or placement in a receiving or treatment
191	facility as defined in s. 394.455 or received mental health
192	services in a forensic or correctional facility. The 36-month
193	period does not include any period during which the person was
194	admitted or incarcerated immediately preceding the filing of the
195	petition and does include acts of noncompliance with the
196	treatment and the current admission for consideration; or
197	b. Engaged in one or more acts of serious violent behavior
198	toward himself or herself or others or engaged in attempts at
199	serious bodily harm to himself or herself or others within the
200	last 36 months. The 36-month period does not include any period
201	in which the person was admitted or incarcerated immediately
202	preceding the filing of the petition and does include acts of
203	violence occurring during the admission or incarceration.
204	6. The person is, as a result of his or her mental
205	illness, unlikely to voluntarily participate in the recommended
206	treatment pursuant to the treatment plan.
207	7. In view of the person’s treatment history and current
208	behavior, the person is in need of involuntary outpatient
209	placement in order to prevent a relapse or deterioration which
210	would be likely to result in serious bodily harm to himself or
211	herself or others, or a substantial harm to his or her well-
212	being as defined in s. 394.463(1).
213	8. It is likely that the person will benefit from
214	involuntary outpatient placement.
215	9. All available less restrictive alternatives which would
216	offer an opportunity for improvement of his or her condition
217	have been judged to be inappropriate.
218	(b) Each required criteria for involuntary outpatient
219	placement must be alleged in the petition and substantiated by
220	hospitalization or arrest records that shall be attached to the
221	petition or a sworn affidavit that shall be attached to the
222	petition. The petition shall consist of a clinical determination
223	by a qualified professional who shall be required to attend the
224	hearing pursuant to subsection (6). The patient shall be allowed
225	an opportunity to present evidence and testimony at the hearing
226	to refute or rebut said allegations.
227	(2) INVOLUNTARY OUTPATIENT PLACEMENT.--
228	(a) A patient may be retained by a receiving facility
229	unless the patient has been stabilized and no longer meets the
230	involuntary examination criteria pursuant to s. 394.463(1), in
231	which case the patient must be placed in outpatient treatment
232	while awaiting the hearing for involuntary outpatient placement
233	upon the recommendation of the administrator of a receiving
234	facility where the patient has been examined and after adherence
235	to the notice and hearing procedures provided in s. 394.4599.
236	The recommendation must be supported by the opinion of a
237	psychiatrist and the second opinion of a clinical psychologist
238	or another psychiatrist, both of whom have personally examined
239	the patient within the preceding 72 hours, that the criteria for
240	involuntary outpatient placement are met. However, in counties
241	of less than 50,000 population, if the administrator certifies
242	that no psychiatrist or clinical psychologist is available to
243	provide the second opinion, such second opinion may be provided
244	by a licensed physician with postgraduate training and
245	experience in diagnosis and treatment of mental and nervous
246	disorders or by a psychiatric nurse. Such recommendation shall
247	be entered on an involuntary outpatient placement certificate,
248	which certificate shall authorize the receiving facility to
249	retain the patient pending transfer to involuntary outpatient
250	placement or completion of a hearing.
251	(b) In cases in which arrangements can be made, a patient
252	may agree to be examined on an outpatient basis for an
253	involuntary outpatient placement certificate. The certificate
254	must be supported by the opinion of a psychiatrist and the
255	second opinion of a clinical psychologist or another
256	psychiatrist, both of whom have personally examined the patient
257	within the preceding 14 calendar days, that the criteria for
258	involuntary outpatient placement are met. However, in counties
259	of less than 50,000 population, if the psychiatrist certifies
260	that no psychiatrist or clinical psychologist is available to
261	provide the second opinion, such second opinion may be provided
262	by a licensed physician with postgraduate training and
263	experience in diagnosis and treatment of mental and nervous
264	disorders or by a psychiatric nurse.
265	(c) If a patient in involuntary inpatient placement meets
266	the criteria for involuntary outpatient placement, the
267	administrator of the treatment facility may, prior to expiration
268	of the period during which the treatment facility is authorized
269	to retain the patient, recommend involuntary outpatient
270	placement. The recommendation must be supported by the opinion
271	of a psychiatrist and the second opinion of a clinical
272	psychologist or another psychiatrist, both of whom have
273	personally examined the patient within the preceding 72 hours,
274	that the criteria for involuntary outpatient placement are met.
275	However, in counties of less than 50,000 population, if the
276	administrator certifies that no psychiatrist or clinical
277	psychologist is available to provide the second opinion, such
278	second opinion may be provided by a licensed physician with
279	postgraduate training and experience in diagnosis and treatment
280	of mental and nervous disorders or by a psychiatric nurse. Such
281	recommendation shall be entered on an involuntary outpatient
282	placement certificate.
283	(3) PETITION FOR INVOLUNTARY OUTPATIENT PLACEMENT.--
284	(a) A petition for involuntary outpatient placement may be
285	filed only when the full range of services that the person needs
286	for mental health treatment and to live and function
287	successfully are available in the patient’s local community. The
288	petitioner must certify in a sworn affidavit attached to the
289	petition the comprehensive array of necessary services, the
290	individual patient’s needs, and the services that are available
291	in the community. A petition may be filed by:
292	1. The administrator of the facility pursuant to paragraph
293	(2)(a);
294	2. One of the examining professionals for persons examined
295	on a voluntary outpatient basis pursuant to paragraph (2)(b).
296	Upon filing, the examining professional shall provide a copy of
297	the petition to the administrator of the receiving facility or
298	designated department representative that will identify the
299	service provider for the involuntary outpatient placement; or
300	3. The administrator of a treatment facility pursuant to
301	paragraph (2)(c). Upon filing, the administrator shall provide a
302	copy of the petition to the administrator of the receiving
303	facility or designated department representative that will
304	identify the service provider for the involuntary outpatient
305	placement.
306	(b) The petition for involuntary outpatient placement
307	shall be filed in the county where the patient is located. Upon
308	filing, the clerk of the court shall provide copies to the
309	department, the patient, the patient's guardian or
310	representative, and the state attorney and public defender of
311	the judicial circuit in which the patient is located. No fee
312	shall be charged for the filing of a petition under this
313	paragraph.
314	(4) APPOINTMENT OF COUNSEL.--Within 1 court working day
315	after the filing of a petition for involuntary outpatient
316	placement, the court shall appoint the public defender to
317	represent the person who is the subject of the petition, unless
318	the person is otherwise represented by counsel. The clerk of the
319	court shall immediately notify the public defender of such
320	appointment. The public defender shall represent the person
321	until the petition is dismissed or the court order expires or
322	the patient is discharged from involuntary outpatient placement.
323	Any attorney representing the patient shall have access to the
324	patient, witnesses, and records relevant to the presentation of
325	the patient's case and shall represent the interests of the
326	patient, regardless of the source of payment to the attorney.
327	(5) CONTINUANCE OF HEARING.--The patient is entitled, with
328	the concurrence of the patient's counsel, to at least one
329	continuance of the hearing. The continuance shall be for a
330	period of up to 4 weeks.
331	(6) HEARING ON INVOLUNTARY OUTPATIENT PLACEMENT.--
332	(a)1. The court shall hold the hearing on involuntary
333	outpatient placement within 5 days after the petition is filed,
334	unless a continuance is granted. The hearing shall be held in
335	the county where the patient is located and shall be as
336	convenient to the patient as may be consistent with orderly
337	procedure and shall be conducted in physical settings not likely
338	to be injurious to the patient's condition. The state attorney
339	for the circuit in which the patient is located shall represent
340	the state, rather than the petitioner, as the real party in
341	interest in the proceeding.
342	2. The court may appoint a master to preside at the
343	hearing. One of the professionals who executed the involuntary
344	outpatient placement certificate shall be a witness. The patient
345	and the patient's guardian or representative shall be informed
346	by the court of the right to an independent expert examination.
347	If the patient cannot afford such an examination, the court
348	shall provide for one. The independent expert's report shall be
349	confidential and not discoverable, unless the expert is to be
350	called as a witness for the patient at the hearing. The court
351	shall allow testimony from individuals, including family
352	members, deemed by the court to be relevant under the law of
353	this state, regarding the person’s prior history, and how that
354	prior history relates to the person’s current condition. The
355	testimony in the hearing must be given under oath and the
356	proceedings must be recorded. The patient may refuse to testify
357	at the hearing.
358	(b)1. If the court concludes that the patient meets the
359	criteria for involuntary outpatient placement pursuant to
360	subsection (1), the court shall issue an order for involuntary
361	outpatient placement. The court order shall be for a period of
362	up to 6 months. The service provider shall discharge a patient
363	any time the patient no longer meets the criteria for
364	involuntary placement.
365	2. The administrator of a receiving facility or designated
366	department representative shall identify the service provider
367	that will have primary responsibility for service provision
368	under the order. The service provider shall prepare a written
369	proposed treatment plan and submit the plan to the court prior
370	to the hearing for the court’s consideration for inclusion in
371	the involuntary outpatient placement order. The treatment plan
372	shall specify the nature and extent of the patient's mental
373	illness. The treatment plan may include provisions for case
374	management, intensive case management, assertive community
375	treatment, or a program for assertive community treatment. The
376	treatment plan may also require that the patient make use of a
377	service provider to supply any of the following categories of
378	services to the individual: medication, periodic urinalysis to
379	determine compliance with treatment, individual or group
380	therapy, day or partial day programming activities, educational
381	and vocational training or activities, alcohol or substance
382	abuse treatment and counseling and periodic tests for the
383	presence of alcohol or illegal drugs for persons with a history
384	of alcohol or substance abuse, supervision of living
385	arrangements, and any other services prescribed to treat the
386	person’s mental illness and to assist the person in living and
387	functioning in the community or to attempt to prevent a relapse
388	or deterioration. The service provider shall certify to the
389	court in the treatment plan that the proposed services are
390	currently available and that the service provider agrees to
391	provide those services. Service providers may select and provide
392	supervision to other individuals not enumerated in this
393	subparagraph to implement specific aspects of the treatment
394	plan, such as medication monitoring. The services in the
395	treatment plan shall be deemed to be clinically appropriate by a
396	physician, clinical psychologist, psychiatric nurse, or clinical
397	social worker who consults with, or is employed or contracted
398	by, the service provider. The court shall not order the
399	department or the service provider to provide services if the
400	program or service is not available in the patient’s local
401	community or there is no space available in the program or
402	service for the patient or if funding is not available for the
403	program or service. A copy of the order shall be sent to the
404	Agency for Health Care Administration. After the placement order
405	is issued, the service provider and the patient can modify
406	provisions of the treatment plan. For any material modification
407	of the provisions of the treatment plan, the service provider
408	shall send notice of the modification to the court. Any material
409	modification of the provisions of the treatment plan that are
410	contested by the patient must be approved by the court.
411	3. When, in the clinical judgment of a physician, the
412	patient has failed or refused to comply with the treatment
413	ordered by the court, efforts were made to solicit compliance,
414	and such patient may meet the criteria for involuntary
415	examination, a person may be brought to a receiving facility
416	pursuant to s. 394.463. If, after examination, the patient does
417	not meet the criteria for involuntary inpatient placement
418	pursuant to s. 394.467, the patient must be discharged from the
419	receiving facility. The service provider must determine whether
420	modifications should be made to the existing treatment plan and
421	attempt to continue to engage the patient in treatment. For any
422	material modification of the provisions of the treatment plan to
423	which the patient or, if appointed, the patient’s guardian
424	advocate does agree, the service provider shall send notice of
425	the modification to the court. Any material modification of the
426	provisions of the treatment plan that are contested by the
427	patient or, if appointed, the patient’s guardian advocate must
428	be approved by the court.
429	(c) If, at any time prior to the conclusion of the initial
430	hearing on involuntary outpatient placement, it appears to the
431	court that the person does not meet the criteria for involuntary
432	outpatient placement under this section but instead meets the
433	criteria for involuntary inpatient placement, the court may
434	order the person admitted for involuntary inpatient placement
435	pursuant to s. 394.467. If the person instead meets the criteria
436	for involuntary assessment, protective custody, or involuntary
437	admission pursuant to s. 397.675, the court may order the person
438	to be admitted for involuntary assessment for a period of 5 days
439	pursuant to s. 397.6811. Thereafter, all proceedings shall be
440	governed by chapter 397.
441	(d) At the hearing on involuntary outpatient placement,
442	the court shall consider testimony and evidence regarding the
443	patient's competence to consent to treatment. If the court finds
444	that the patient is incompetent to consent to treatment, the
445	court shall appoint a guardian advocate as provided in s.
446	394.4598 from a list of qualified and available guardian
447	advocates submitted to the court with the petition. The guardian
448	advocate’s role shall be to monitor the patient’s care to ensure
449	that the patient’s rights are protected. The guardian advocate
450	is immune from liability under this provision. If the patient,
451	the patient’s guardian advocate, and the service provider agree
452	that the guardian advocate is no longer needed because the
453	person is competent, the guardian advocate may be discharged.
454	(e) The administrator of the receiving facility or
455	designated department representative shall provide a copy of the
456	court order and adequate documentation of a patient's mental
457	illness to the service provider for involuntary outpatient
458	placement. Such documentation shall include any advance
459	directives made by the patient, a psychiatric evaluation of the
460	patient, and any evaluations of the patient performed by a
461	clinical psychologist or a clinical social worker.
462	(7) PROCEDURE FOR CONTINUED INVOLUNTARY OUTPATIENT
463	PLACEMENT.--
464	(a) If the person continues to meet the criteria for
465	involuntary outpatient placement, the service provider shall,
466	prior to the expiration of the period during which the treatment
467	is ordered for the person, file in the circuit court a continued
468	involuntary outpatient placement certificate which shall be
469	accompanied by a statement from the person’s physician or
470	clinical psychologist justifying the request, a brief
471	description of the patient's treatment during the time he or she
472	was involuntarily placed, and an individualized plan of
473	continued treatment.
474	(b) Within 1 court working day after the filing of a
475	petition for continued involuntary outpatient placement, the
476	court shall appoint the public defender to represent the person
477	who is the subject of the petition, unless the person is
478	otherwise represented by counsel. The clerk of the court shall
479	immediately notify the public defender of such appointment. The
480	public defender shall represent the person until the petition is
481	dismissed, the court order expires, or the patient is discharged
482	from involuntary outpatient placement. Any attorney representing
483	the patient shall have access to the patient, witnesses, and
484	records relevant to the presentation of the patient's case and
485	shall represent the interests of the patient, regardless of the
486	source of payment to the attorney.
487	(c) Hearings on petitions for continued involuntary
488	outpatient placement shall be before the circuit court. The
489	court may appoint a master to preside at the hearing. The
490	procedures for obtaining an order pursuant to this paragraph
491	shall be in accordance with the provisions of subsection (6),
492	except that the time period included in subparagraph (1)(a)5.
493	shall not apply in determining the appropriateness of additional
494	periods of involuntary outpatient placement.
495	(d) Notice of the hearing shall be provided as set forth
496	in s. 394.4599.
497	(e) The same procedure shall be repeated prior to the
498	expiration of each additional period the patient is placed in
499	treatment.
500	(f) If the patient has been previously found incompetent
501	to consent to treatment, the court shall consider testimony and
502	evidence regarding the patient's competence. If the court finds
503	evidence that the patient has become competent to consent to
504	treatment, the court may order that any guardian advocate
505	previously appointed be discharged.
506	Section 16. Section 394.467, Florida Statutes, is amended
507	to read:
508	394.467 Involuntary inpatientplacement.--
509	(1) CRITERIA.--A person may be involuntarily placed in
510	involuntary inpatient placementfor treatment upon a finding of
511	the court by clear and convincing evidence that:
512	(a) He or she is mentally ill and because of his or her
513	mental illness:
514	1.a. He or she has refused voluntary placement for
515	treatment after sufficient and conscientious explanation and
516	disclosure of the purpose of placement for treatment; or
517	b. He or she is unable to determine for himself or herself
518	whether placement is necessary; and
519	2.a. He or she is manifestly incapable of surviving alone
520	or with the help of willing and responsible family or friends,
521	including available alternative services, and, without
522	treatment, is likely to suffer from neglect or refuse to care
523	for himself or herself, and such neglect or refusal poses a real
524	and present threat of substantial harm to his or her well-being;
525	or
526	b. There is substantial likelihood that in the near future
527	he or she will inflict serious bodily harm on himself or herself
528	or another person, as evidenced by recent behavior causing,
529	attempting, or threatening such harm; and
530	(b) All available less restrictive treatment alternatives
531	which would offer an opportunity for improvement of his or her
532	condition have been judged to be inappropriate.
533	(2) ADMISSION TO A TREATMENT FACILITY.--A patient may be
534	retained by a receiving facility or involuntarily placed in a
535	treatment facility upon the recommendation of the administrator
536	of a receiving facility where the patient has been examined and
537	after adherence to the notice and hearing procedures provided in
538	s. 394.4599. The recommendation must be supported by the opinion
539	of a psychiatrist and the second opinion of a clinical
540	psychologist or another psychiatrist, both of whom have
541	personally examined the patient within the preceding 72 hours,
542	that the criteria for involuntary inpatientplacement are met.
543	However, in counties of less than 50,000 population, if the
544	administrator certifies that no psychiatrist or clinical
545	psychologist is available to provide the second opinion, such
546	second opinion may be provided by a licensed physician with
547	postgraduate training and experience in diagnosis and treatment
548	of mental and nervous disorders or by a psychiatric nurse. Such
549	recommendation shall be entered on an involuntary inpatient
550	placement certificate, which certificate shall authorize the
551	receiving facility to retain the patient pending transfer to a
552	treatment facility or completion of a hearing.
553	(3) PETITION FOR INVOLUNTARY INPATIENTPLACEMENT.--The
554	administrator of the facility shall file a petition for
555	involuntary inpatientplacement in the court in the county where
556	the patient is located. Upon filing, the clerk of the court
557	shall provide copies to the department, the patient, the
558	patient's guardian or representative, and the state attorney and
559	public defender of the judicial circuit in which the patient is
560	located. No fee shall be charged for the filing of a petition
561	under this subsection.
562	(4) APPOINTMENT OF COUNSEL.--Within 1 court working day
563	after the filing of a petition for involuntary inpatient
564	placement, the court shall appoint the public defender to
565	represent the person who is the subject of the petition, unless
566	the person is otherwise represented by counsel. The clerk of the
567	court shall immediately notify the public defender of such
568	appointment. Any attorney representing the patient shall have
569	access to the patient, witnesses, and records relevant to the
570	presentation of the patient's case and shall represent the
571	interests of the patient, regardless of the source of payment to
572	the attorney.
573	(5) CONTINUANCE OF HEARING.--The patient is entitled, with
574	the concurrence of the patient's counsel, to at least one
575	continuance of the hearing. The continuance shall be for a
576	period of up to 4 weeks.
577	(6) HEARING ON INVOLUNTARY INPATIENTPLACEMENT.--
578	(a)1. The court shall hold the hearing on involuntary
579	inpatientplacement within 5 days, unless a continuance is
580	granted. The hearing shall be held in the county where the
581	patient is located and shall be as convenient to the patient as
582	may be consistent with orderly procedure and shall be conducted
583	in physical settings not likely to be injurious to the patient's
584	condition. If the court finds that the patient's attendance at
585	the hearing is not consistent with the best interests of the
586	patient, and the patient's counsel does not object, the court
587	may waive the presence of the patient from all or any portion of
588	the hearing. The state attorney for the circuit in which the
589	patient is located shall represent the state, rather than the
590	petitioning facility administrator, as the real party in
591	interest in the proceeding.
592	2. The court may appoint a master to preside at the
593	hearing. One of the professionals who executed the involuntary
594	inpatientplacement certificate shall be a witness. The patient
595	and the patient's guardian or representative shall be informed
596	by the court of the right to an independent expert examination.
597	If the patient cannot afford such an examination, the court
598	shall provide for one. The independent expert's report shall be
599	confidential and not discoverable, unless the expert is to be
600	called as a witness for the patient at the hearing. The
601	testimony in the hearing must be given under oath, and the
602	proceedings must be recorded. The patient may refuse to testify
603	at the hearing.
604	(b) If the court concludes that the patient meets the
605	criteria for involuntary inpatientplacement, it shall order
606	that the patient be transferred to a treatment facility or, if
607	the patient is at a treatment facility, that the patient be
608	retained there or be treated at any other appropriate receiving
609	or treatment facility, or that the patient receive services from
610	a receiving or treatment facility, on an involuntary basis, for
611	a period of up to 6 months. The order shall specify the nature
612	and extent of the patient's mental illness. The facility shall
613	discharge a patient any time the patient no longer meets the
614	criteria for involuntary inpatientplacement, unless the patient
615	has transferred to voluntary status.
616	(c) If at any time prior to the conclusion of the hearing
617	on involuntary inpatientplacement it appears to the court that
618	the person does not meet the criteria for involuntary inpatient
619	placement under this sectionchapter, but instead meets the
620	criteria for involuntary outpatient placement, the court may
621	order the person evaluated for involuntary outpatient placement
622	pursuant to s. 394.466. The petition and hearing procedures set
623	forth in s. 394.466 shall apply. If the personinstead meets the
624	criteria for involuntary assessment, protective custody, or
625	involuntary admission pursuant to s. 397.675, then the court may
626	order the person to be admitted for involuntary assessment for a
627	period of 5 days pursuant to s. 397.6811. Thereafter, all
628	proceedings shall be governed by chapter 397.
629	(d) At the hearing on involuntary inpatientplacement, the
630	court shall consider testimony and evidence regarding the
631	patient's competence to consent to treatment. If the court finds
632	that the patient is incompetent to consent to treatment, it
633	shall appoint a guardian advocate as provided in s. 394.4598.
634	(e) The administrator of the receiving facility shall
635	provide a copy of the court order and adequate documentation of
636	a patient's mental illness to the administrator of a treatment
637	facility whenever a patient is ordered for involuntary inpatient
638	placement, whether by civil or criminal court. Such
639	documentation shall include any advance directives made by the
640	patient, a psychiatric evaluation of the patient, and any
641	evaluations of the patient performed by a clinical psychologist
642	or a clinical social worker. The administrator of a treatment
643	facility may refuse admission to any patient directed to its
644	facilities on an involuntary basis, whether by civil or criminal
645	court order, who is not accompanied at the same time by adequate
646	orders and documentation.
647	(7) PROCEDURE FOR CONTINUED INVOLUNTARY INPATIENT
648	PLACEMENT.--
649	(a) Hearings on petitions for continued involuntary
650	inpatientplacement shall be administrative hearings and shall
651	be conducted in accordance with the provisions of s. 120.57(1),
652	except that any order entered by the hearing officer shall be
653	final and subject to judicial review in accordance with s.
654	120.68. Orders concerning patients committed after successfully
655	pleading not guilty by reason of insanity shall be governed by
656	the provisions of s. 916.15.
657	(b) If the patient continues to meet the criteria for
658	involuntary inpatientplacement, the administrator shall, prior
659	to the expiration of the period during which the treatment
660	facility is authorized to retain the patient, file a petition
661	requesting authorization for continued involuntary inpatient
662	placement. The request shall be accompanied by a statement from
663	the patient's physician or clinical psychologist justifying the
664	request, a brief description of the patient's treatment during
665	the time he or she was involuntarily placed, and an
666	individualized plan of continued treatment. Notice of the
667	hearing shall be provided as set forth in s. 394.4599. If at the
668	hearing the hearing officer finds that attendance at the hearing
669	is not consistent with the best interests of the patient, the
670	hearing officer may waive the presence of the patient from all
671	or any portion of the hearing, unless the patient, through
672	counsel, objects to the waiver of presence. The testimony in the
673	hearing must be under oath, and the proceedings must be
674	recorded.
675	(c) Unless the patient is otherwise represented or is
676	ineligible, he or she shall be represented at the hearing on the
677	petition for continued involuntary inpatientplacement by the
678	public defender of the circuit in which the facility is located.
679	(d) If at a hearing it is shown that the patient continues
680	to meet the criteria for involuntary inpatientplacement, the
681	administrative law judge shall sign the order for continued
682	involuntary inpatientplacement for a period not to exceed 6
683	months. The same procedure shall be repeated prior to the
684	expiration of each additional period the patient is retained.
685	(e) If continued involuntary inpatientplacement is
686	necessary for a patient admitted while serving a criminal
687	sentence, but whose sentence is about to expire, or for a
688	patient involuntarily placed while a minor but who is about to
689	reach the age of 18, the administrator shall petition the
690	administrative law judge for an order authorizing continued
691	involuntary inpatientplacement.
692	(f) If the patient has been previously found incompetent
693	to consent to treatment, the hearing officer shall consider
694	testimony and evidence regarding the patient's competence. If
695	the hearing officer finds evidence that the patient is now
696	competent to consent to treatment, the hearing officer may issue
697	a recommended order to the court that found the patient
698	incompetent to consent to treatment that the patient's
699	competence be restored and that any guardian advocate previously
700	appointed be discharged.
701	(8) RETURN OF PATIENTS.--When a patient at a treatment
702	facility leaves the facility without authorization, the
703	administrator may authorize a search for the patient and the
704	return of the patient to the facility. The administrator may
705	request the assistance of a law enforcement agency in the search
706	for and return of the patient.
707	Section 17. Involuntary Outpatient Placement
708	Implementation Task Force.--
709	(1) The Involuntary Outpatient Placement Implementation
710	Task Force is established to develop a plan for implementation
711	of the involuntary outpatient placement procedures established
712	in this act. The task force shall include a representative from
713	each of the following entities, to be designated by their
714	respective organizations no later than July 1, 2003: the Florida
715	Sheriffs Association, the Florida Police Chiefs Association, the
716	Florida Public Defender Association, Inc., the Florida
717	Prosecuting Attorneys Association, the Florida Association of
718	Court Clerks, the Florida Association of Counties, the
719	Department of Children and Family Services, the Florida Council
720	for Community Mental Health, and the Agency for Health Care
721	Administration. Additionally, a member of the Senate shall be
722	designated by the President of the Senate, a member of the House
723	of Representatives shall be designated by the Speaker of the
724	House of Representatives, a representative of the Executive
725	Office of the Governor shall be designated by the Governor, and
726	a circuit judge shall be designated by the Chief Justice of the
727	Supreme Court to serve on the task force. The representative for
728	the Florida Sheriffs Association and the circuit judge shall be
729	designated by the Chief Justice of the Florida Supreme Court and
730	shall serve as co-chairs of the task force. The task force
731	should solicit and receive input from interested parties.
732	(2) The task force shall be convened no later than August
733	1, 2003. Staff support for the initial meeting shall be provided
734	by staff of the House Committee on the Future of Florida’s
735	Families and the Senate Committee on Children and Families. The
736	co-chairs shall facilitate the meetings and make appropriate
737	arrangements for staff support of subsequent meetings and
738	preparation of an implementation plan and report. Expenses
739	associated with task force meetings and work products shall be
740	the responsibility of each member’s organization.
741	(3) The task force shall prepare an implementation plan
742	and report that identifies issues and proposed strategies for
743	implementation of court-ordered mental health treatment on an
744	outpatient basis. The task force shall also address issues,
745	including, but not limited to, recommendations for an evaluation
746	process to determine the effectiveness of involuntary outpatient
747	placement and proposed technical amendments to the Florida
748	Statutes to improve implementation, if necessary and
749	appropriate. The implementation plan and report must recommend a
750	process to collect data that reflects the impact of involuntary
751	outpatient placement on the courts, state attorneys, public
752	defenders, clerks of court, law enforcement, jails, and the
753	mental health treatment system. The report must be submitted by
754	December 1, 2003, to the Governor, the President of the Senate,
755	the Speaker of the House of Representatives, and the Chief
756	Justice of the Florida Supreme Court.
757	Section 18. Any additional costs or expenses related to
758	implementation and enforcement of this act by the judiciary of
759	this state shall be a local requirement pursuant to chapter 29,
760	Florida Statutes.
761	Section 19. If any provision of this act or its
762	application to any person or circumstance is held invalid, the
763	invalidity does not affect other provisions or applications of
764	the act which can be given effect without the invalid provision
765	or application, and to this end the provisions of this act are
766	severable.
767
768	================= T I T L E A M E N D M E N T =================
769	On page 4, line(s) 27 and 28,
770	remove: all of said lines
771	and insert: prior to implementation; amending s. 394.455,
772	F.S.; revising a definition; providing additional
773	definitions; amending s. 394.4598, F.S.; revising language
774	with respect to the guardian advocate; authorizing the
775	guardian advocate to consent to administration of
776	medication over objection under certain circumstances;
777	amending s. 394.4615, F.S.; providing for release of
778	certain clinical records to certain persons for certain
779	purposes; amending s. 394.463, F.S.; revising criteria and
780	procedures for involuntary examination; creating s.
781	394.466, F.S.; setting forth criteria for involuntary
782	outpatient placement; providing contents of a petition for
783	involuntary outpatient placement; specifying procedures
784	for involuntary outpatient placement; providing for
785	persons who may file a petition for involuntary outpatient
786	placement; providing for appointment of counsel; providing
787	for continuance of hearings; providing for a hearing on
788	involuntary outpatient placement; setting forth procedures
789	for the hearing; providing for appointment of a master to
790	preside; providing for an independent examination;
791	requiring a court to order involuntary outpatient
792	placement under certain circumstances; requiring a
793	treatment plan; providing for plan modification; providing
794	for a patient to be brought to a receiving facility upon
795	failure or refusal to comply with the treatment plan;
796	providing for involuntary inpatient placement or
797	involuntary assessment; requiring consideration of a
798	patient’s competence to proceed; requiring a list of
799	guardian advocates to be submitted to the court; defining
800	the role of a guardian advocate; providing for discharge
801	of the guardian advocate; requiring certain documentation;
802	allowing a person for whom an involuntary outpatient
803	placement petition has been filed to agree to a voluntary
804	treatment agreement; specifying requirements for
805	agreements; providing for modifications; providing for
806	filing of an affidavit of noncompliance with a voluntary
807	treatment plan; requiring a hearing; requiring dismissal
808	of petitions in certain circumstances; providing
809	procedures for continued involuntary outpatient placement;
810	providing for a continued involuntary outpatient placement
811	certificate; requiring a hearing; requiring appointment of
812	a public defender; requiring hearings; providing for
813	appointment of a special master; amending s. 394.467,
814	F.S.; revising language with respect to involuntary
815	inpatient placement; providing a reference to inpatient
816	and outpatient involuntary placement; providing
817	requirements for placement orders; providing for voluntary
818	treatment agreements; providing a procedure for continued
819	involuntary outpatient placement; establishing the
820	Involuntary Outpatient Placement Implementation Task
821	Force; providing purposes; providing for membership;
822	providing for meetings; requiring the task force to
823	prepare an implementation plan relating to court-ordered
824	mental health outpatient treatment; requiring a report to
825	the Governor, Legislature, and Florida Supreme Court;
826	specifying certain costs or expenses related to
827	implementation and enforcement by the state judiciary as a
828	local requirement; providing for severability; providing
829	an effective dates.
830
831	WHEREAS, untreated mental illness is a difficult issue
832	confronting every Florida community, and
833	WHEREAS, there are Floridians with severe mental illnesses
834	who are prone to relapse, often fail to comply with their
835	treatment plans, and have repeated hospitalizations and criminal
836	justice contacts, who are sometimes referred to as "Baker Act
837	recidivists," and
838	WHEREAS, many states use some form of civil commitment to
839	compel Baker Act recidivists to undergo treatment on an
840	involuntary outpatient basis, and
841	WHEREAS, it is the intent of the Legislature to protect
842	public safety and ensure that Baker Act recidivists receive
843	needed mental health services, while preserving the due process
844	rights of individuals with mental illness, and
845	WHEREAS, implementation and oversight of the involuntary
846	outpatient placement system involves the cooperative efforts and
847	combined resources of the Department of Children and Family
848	Services, the offices of the state attorneys, the offices of the
849	public defenders, the state courts, the clerks of court, and law
850	enforcement, among others, and
851	WHEREAS, the State of Florida is facing numerous
852	unprecedented fiscal challenges, some of which have a direct
853	bearing on involuntary outpatient placement, including revenue
854	shortfalls, the transition to state funding of the judicial
855	branch pursuant to Article V Revision 7, consideration of the
856	proper placement of the Mental Health Program Office, and
857	development of strategies to address the staggering growth in
858	Medicaid spending, and
859	WHEREAS, it is the intent of the Legislature to address
860	this issue in a deliberative, thoughtful process which allows
861	consideration of the difficult fiscal issues presented by a
862	statutory process for involuntary outpatient placement and to
863	appoint a task force to make recommendations on the effectuation
864	of court-ordered outpatient mental health treatment in
865	sufficient time to allow the stakeholders and funding entities
866	to adequately prepare for implementation in fiscal year 2004-
867	2005, NOW, THEREFORE,
868