Florida Senate - 2011                          SENATOR AMENDMENT
       Bill No. CS/HB 7109, 2nd Eng.
                                Barcode 688740                          
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
                 Floor: WD/2R          .                                
             05/05/2011 04:58 PM       .                                

       Senator Storms moved the following:
    1         Senate Amendment to Amendment (351842) (with title
    2  amendment)
    4         Between lines 4 and 5
    5  insert:
    6         Section 1. Paragraphs (c) and (d) of subsection (3) of
    7  section 39.407, Florida Statutes, are amended to read:
    8         39.407 Medical, psychiatric, and psychological examination
    9  and treatment of child; physical, mental, or substance abuse
   10  examination of person with or requesting child custody.—
   11         (3)
   12         (c) Except as provided in paragraphs (b) and (e), the
   13  department must file a motion seeking the court’s authorization
   14  to initially provide or continue to provide psychotropic
   15  medication to a child in its legal custody. The motion must be
   16  supported by a written report prepared by the department which
   17  describes the efforts made to enable the prescribing physician
   18  to obtain express and informed consent to provide for providing
   19  the medication to the child and other treatments considered or
   20  recommended for the child. In addition, The motion must also be
   21  supported by the prescribing physician’s signed medical report
   22  providing:
   23         1. The name of the child, the name and range of the dosage
   24  of the psychotropic medication, and the that there is a need to
   25  prescribe psychotropic medication to the child based upon a
   26  diagnosed condition for which such medication is being
   27  prescribed.
   28         2. A statement indicating that the physician has reviewed
   29  all medical information concerning the child which has been
   30  provided.
   31         3. A statement indicating that the psychotropic medication,
   32  at its prescribed dosage, is appropriate for treating the
   33  child’s diagnosed medical condition, as well as the behaviors
   34  and symptoms the medication, at its prescribed dosage, is
   35  expected to address.
   36         4. An explanation of the nature and purpose of the
   37  treatment; the recognized side effects, risks, and
   38  contraindications of the medication; drug-interaction
   39  precautions; the possible effects of stopping the medication;
   40  and how the treatment will be monitored, followed by a statement
   41  indicating that this explanation was provided to the child if
   42  age appropriate and to the child’s caregiver.
   43         5. Documentation addressing whether the psychotropic
   44  medication will replace or supplement any other currently
   45  prescribed medications or treatments; the length of time the
   46  child is expected to be taking the medication; and any
   47  additional medical, mental health, behavioral, counseling, or
   48  other services that the prescribing physician recommends.
   49         6. For a child 10 years of age or younger who is in an out
   50  of-home placement, the results of a review of the administration
   51  of the medication by a child psychiatrist who is licensed under
   52  chapter 458 or chapter 459. The review must be provided to the
   53  child and the parent or legal guardian before final express and
   54  informed consent is given. The review must include a
   55  determination of the following:
   56         a. The presence of a genetic psychiatric disorder or a
   57  family history of a psychiatric disorder;
   58         b. Whether the cause of a psychiatric disorder is physical
   59  or environmental; and
   60         c. The likelihood of the child being an imminent danger to
   61  self or others.
   62         (d)1. The department must notify all parties of the
   63  proposed action taken under paragraph (c) in writing or by
   64  whatever other method best ensures that all parties receive
   65  notification of the proposed action within 48 hours after the
   66  motion is filed. If any party objects to the department’s
   67  motion, that party shall file the objection within 2 working
   68  days after being notified of the department’s motion. If any
   69  party files an objection to the authorization of the proposed
   70  psychotropic medication, the court shall hold a hearing as soon
   71  as possible before authorizing the department to initially
   72  provide or to continue providing psychotropic medication to a
   73  child in the legal custody of the department.
   74         1. At such hearing and notwithstanding s. 90.803, the
   75  medical report described in paragraph (c) is admissible in
   76  evidence. The prescribing physician need not attend the hearing
   77  or testify unless the court specifically orders such attendance
   78  or testimony, or a party subpoenas the physician to attend the
   79  hearing or provide testimony.
   80         2. If, after considering any testimony received, the court
   81  finds that the department’s motion and the physician’s medical
   82  report meet the requirements of this subsection and that it is
   83  in the child’s best interests, the court may order that the
   84  department provide or continue to provide the psychotropic
   85  medication to the child without additional testimony or
   86  evidence.
   87         3. At any hearing held under this paragraph, the court
   88  shall further inquire of the department as to whether additional
   89  medical, mental health, behavioral, counseling, or other
   90  services are being provided to the child by the department which
   91  the prescribing physician considers to be necessary or
   92  beneficial in treating the child’s medical condition and which
   93  the physician recommends or expects to provide to the child in
   94  concert with the medication. The court may order additional
   95  medical consultation, including consultation with the MedConsult
   96  line at the University of Florida, if available, or require the
   97  department to obtain a second opinion within a reasonable
   98  timeframe as established by the court, not to exceed 21 calendar
   99  days, after such order based upon consideration of the best
  100  interests of the child. The department must make a referral for
  101  an appointment for a second opinion with a physician within 1
  102  working day.
  103         4. The court may not order the discontinuation of
  104  prescribed psychotropic medication if such order is contrary to
  105  the decision of the prescribing physician unless the court first
  106  obtains an opinion from a licensed psychiatrist, if available,
  107  or, if not available, a physician licensed under chapter 458 or
  108  chapter 459, stating that more likely than not, discontinuing
  109  the medication would not cause significant harm to the child.
  110  If, however, the prescribing psychiatrist specializes in mental
  111  health care for children and adolescents, the court may not
  112  order the discontinuation of prescribed psychotropic medication
  113  unless the required opinion is also from a psychiatrist who
  114  specializes in mental health care for children and adolescents.
  115  The court may also order the discontinuation of prescribed
  116  psychotropic medication if a child’s treating physician,
  117  licensed under chapter 458 or chapter 459, states that
  118  continuing the prescribed psychotropic medication would cause
  119  significant harm to the child due to a diagnosed nonpsychiatric
  120  medical condition.
  121         5. If a child who is in out-of-home placement is 10 years
  122  of age or younger, psychotropic medication may not be authorized
  123  by the court absent a finding of a compelling governmental
  124  interest. In making such finding, the court shall consider the
  125  findings of the psychiatric review described in subparagraph
  126  (c)6.
  127         6.2. The burden of proof at any hearing held under this
  128  paragraph shall be by a preponderance of the evidence.
  130  ================= T I T L E  A M E N D M E N T ================
  131         And the title is amended as follows:
  132         Delete line 3982
  133  and insert:
  134         An act relating to Medicaid; amending s. 39.407, F.S.;
  135         requiring a motion by the Department of Children and
  136         Family Services to provide psychotropic medication to
  137         a child 10 years of age or younger to include a review
  138         by a child psychiatrist; providing that a court may
  139         not authorize the administration of such medication
  140         absent a finding of compelling state interest based on
  141         the review; amending s. 393.0661,