Florida Senate - 2011                          SENATOR AMENDMENT
       Bill No. CS/HB 7109, 2nd Eng.
                                Barcode 695454                          
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
                  Floor: WD            .                                
             05/06/2011 09:32 AM       .                                

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