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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
A bill to be entitled 1
An act relating to outpatient health services; 2
amending s. 394.4599, F.S.; revising written notice 3
requirements relating to filing petitions for 4
involuntary services; amending s. 394.4615, F.S.; 5
conforming provisions to changes made by the act; 6
amending s. 394.463, F.S.; authorizing, rather than 7
requiring, law enforcement officers to take certain 8
persons into custody for involuntary examinations; 9
requiring written reports by law enforcement officers 10
to contain certain information; removing a provision 11
prohibiting a psychiatric nurse from approving the 12
release of a patient under certain circumstances; 13
revising the types of documents that the department is 14
required to receive and maintain and that are 15
considered part of the clinical record; requiring the 16
department to post a specified report on its website; 17
revising requirements for releasing a patient from a 18
receiving facility; revising requirements for 19
petitions for involuntary services; amending s. 20
394.4655, F.S.; defining the term "involuntary 21
outpatient placement"; authorizing a court to order a 22
respondent into outpatient treatment under certain 23
circumstances; removing provisions relating to 24
criteria, retention of a patient, and petition for 25
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
involuntary outpatient services and court proceedings 26
relating to involuntary outpatient services; amending 27
s. 394.467, F.S.; providing definitions; revising 28
requirements for ordering a person for involuntary 29
services and treatment, petitions for involuntary 30
services, appointment of counsel, and continuances of 31
hearings, respectively; revising the conditions under 32
which a court may waive the requirement for a patient 33
to be present at an involuntary inpatient placement 34
hearing; authorizing the court to permit witnesses to 35
attend and testify remotely at the hearing through 36
specified means; providing requirements for a witness 37
to attend and testify remotely; requiring facilities 38
to make certain clinical records available to a state 39
attorney within a specified timeframe; specifying that 40
such records remain confidential and may not be used 41
for certain purposes; revising the circumstances under 42
which a court may appoint a magistrate to preside over 43
certain proceedings; requiring the court to allow 44
certain testimony from specified persons; revising the 45
length of time a court may r equire a patient to 46
receive services; requiring facilities to discharge 47
patients when they no longer meet the criteria for 48
involuntary inpatient treatment; prohibiting courts 49
from ordering individuals with developmental 50
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
disabilities to be involuntarily pla ced in a state 51
treatment facility; requiring courts to refer such 52
individuals, and authorizing courts to refer certain 53
other individuals, to specified agencies for 54
evaluation and services; providing requirements for 55
treatment plan modifications, noncomplia nce with 56
involuntary outpatient services, and discharge, 57
respectively; revising requirements for the procedure 58
for continued involuntary services and return to 59
treatment facilities, respectively; amending ss. 60
394.492, 394.495, 394.496, 394.9085, 409.972, 4 64.012, 61
and 744.2007, F.S.; conforming provisions and cross -62
references to changes made by the act; providing an 63
effective date. 64
65
Be It Enacted by the Legislature of the State of Florida: 66
67
Section 1. Paragraph (d) of subsection (2) of section 68
394.4599, Florida Statutes, is amended to read: 69
394.4599 Notice.— 70
(2) INVOLUNTARY ADMISSION. — 71
(d) The written notice of the filing of the petition for 72
involuntary services for an individual being held must contain 73
the following: 74
1. Notice that the petiti on for: 75
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
a. Involuntary services inpatient treatment pursuant to s. 76
394.467 has been filed with the circuit court and the address of 77
such court in the county in which the individual is hospitalized 78
and the address of such court ; or 79
b. Involuntary outpat ient services pursuant to s. 394.467 80
s. 394.4655 has been filed with the criminal county court, as 81
defined in s. 394.4655(1), or the circuit court, as applicable, 82
in the county in which the individual is hospitalized and the 83
address of such court. 84
2. Notice that the office of the public defender has been 85
appointed to represent the individual in the proceeding, if the 86
individual is not otherwise represented by counsel. 87
3. The date, time, and place of the hearing and the name 88
of each examining expert and every other person expected to 89
testify in support of continued detention. 90
4. Notice that the individual, the individual's guardian, 91
guardian advocate, health care surrogate or proxy, or 92
representative, or the administrator may apply for a change of 93
venue for the convenience of the parties or witnesses or because 94
of the condition of the individual. 95
5. Notice that the individual is entitled to an 96
independent expert examination and, if the individual cannot 97
afford such an examination, that the court will p rovide for one. 98
Section 2. Subsection (3) of section 394.4615, Florida 99
Statutes, is amended to read: 100
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
394.4615 Clinical records; confidentiality. — 101
(3) Information from the clinical record may be released 102
in the following circumstances: 103
(a) When a patient has communicated to a service provider 104
a specific threat to cause serious bodily injury or death to an 105
identified or a readily available person, if the service 106
provider reasonably believes, or should reasonably believe 107
according to the standards of his or her profession, that the 108
patient has the apparent intent and ability to imminently or 109
immediately carry out such threat. When such communication has 110
been made, the administrator may authorize the release of 111
sufficient information to provide adequat e warning to the person 112
threatened with harm by the patient. 113
(b) When the administrator of the facility or secretary of 114
the department deems release to a qualified researcher as 115
defined in administrative rule, an aftercare treatment provider, 116
or an employee or agent of the department is necessary for 117
treatment of the patient, maintenance of adequate records, 118
compilation of treatment data, aftercare planning, or evaluation 119
of programs. 120
121
For the purpose of determining whether a person meets the 122
criteria for involuntary services outpatient placement or for 123
preparing the proposed treatment plan pursuant to s. 394.4655 or 124
s. 394.467, the clinical record may be released to the state 125
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
attorney, the public defender or the patient's private legal 126
counsel, the court, and to the appropriate mental health 127
professionals, including the service provider under s. 394.4655 128
or s. 394.467 identified in s. 394.4655(7)(b)2. , in accordance 129
with state and federal law. 130
Section 3. Subsection (1) and paragraphs (a), (e), (f), 131
(g), and (h) of subsection (2) of section 394.463, Florida 132
Statutes, are amended to read: 133
394.463 Involuntary examination. — 134
(1) CRITERIA.—A person may be taken to a receiving 135
facility for involuntary examination if there is reason to 136
believe that the pers on has a mental illness and because of his 137
or her mental illness: 138
(a)1. The person has refused voluntary examination after 139
conscientious explanation and disclosure of the purpose of the 140
examination; or 141
2. The person is unable to determine for himself o r 142
herself whether examination is necessary; and 143
(b)1. Without care or treatment, the person is likely to 144
suffer from neglect or refuse to care for himself or herself; 145
such neglect or refusal poses a real and present threat of 146
substantial harm to his or h er well-being; and it is not 147
apparent that such harm may be avoided through the help of 148
willing, able, and responsible family members or friends or the 149
provision of other services; or 150
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2. There is a substantial likelihood that without care or 151
treatment the person will cause serious bodily harm to himself 152
or herself or others in the near future, as evidenced by recent 153
behavior. 154
(2) INVOLUNTARY EXAMINATION. — 155
(a) An involuntary examination may be initiated by any one 156
of the following means: 157
1. A circuit or county court may enter an ex parte order 158
stating that a person appears to meet the criteria for 159
involuntary examination and specifying the findings on which 160
that conclusion is based. The ex parte order for involuntary 161
examination must be based on writt en or oral sworn testimony 162
that includes specific facts that support the findings. If other 163
less restrictive means are not available, such as voluntary 164
appearance for outpatient evaluation, a law enforcement officer, 165
or other designated agent of the court, shall take the person 166
into custody and deliver him or her to an appropriate, or the 167
nearest, facility within the designated receiving system 168
pursuant to s. 394.462 for involuntary examination. The order of 169
the court shall be made a part of the patient's c linical record. 170
A fee may not be charged for the filing of an order under this 171
subsection. A facility accepting the patient based on this order 172
must send a copy of the order to the department within 5 working 173
days. The order may be submitted electronically through existing 174
data systems, if available. The order shall be valid only until 175
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the person is delivered to the facility or for the period 176
specified in the order itself, whichever comes first. If a time 177
limit is not specified in the order, the order is va lid for 7 178
days after the date that the order was signed. 179
2. A law enforcement officer may shall take a person who 180
appears to meet the criteria for involuntary examination into 181
custody and deliver the person or have him or her delivered to 182
an appropriate, or the nearest, facility within the designated 183
receiving system pursuant to s. 394.462 for examination. A law 184
enforcement officer transporting a person pursuant to this 185
section subparagraph shall restrain the person in the least 186
restrictive manner availab le and appropriate under the 187
circumstances. The officer shall execute a written report 188
detailing the circumstances under which the person was taken 189
into custody, which must be made a part of the patient's 190
clinical record. The report must include all emerge ncy contact 191
information for the person that is readily accessible to the law 192
enforcement officer, including information available through 193
electronic databases maintained by the Department of Law 194
Enforcement or by the Department of Highway Safety and Motor 195
Vehicles. Such emergency contact information may be used by a 196
receiving facility only for the purpose of informing listed 197
emergency contacts of a patient's whereabouts pursuant to s. 198
119.0712(2)(d). Any facility accepting the patient based on this 199
report must send a copy of the report to the department within 5 200
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
working days. 201
3. A physician, a physician assistant, a clinical 202
psychologist, a psychiatric nurse, an advanced practice 203
registered nurse registered under s. 464.0123, a mental health 204
counselor, a marriage and family therapist, or a clinical social 205
worker may execute a certificate stating that he or she has 206
examined a person within the preceding 48 hours and finds that 207
the person appears to meet the criteria for involuntary 208
examination and stating th e observations upon which that 209
conclusion is based. If other less restrictive means, such as 210
voluntary appearance for outpatient evaluation, are not 211
available, a law enforcement officer shall take into custody the 212
person named in the certificate and delive r him or her to the 213
appropriate, or nearest, facility within the designated 214
receiving system pursuant to s. 394.462 for involuntary 215
examination. The law enforcement officer shall execute a written 216
report detailing the circumstances under which the person w as 217
taken into custody and include all emergency contact information 218
required under subparagraph 2 . The report must include all 219
emergency contact information for the person that is readily 220
accessible to the law enforcement officer, including information 221
available through electronic databases maintained by the 222
Department of Law Enforcement or by the Department of Highway 223
Safety and Motor Vehicles. Such emergency contact information 224
may be used by a receiving facility only for the purpose of 225
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
informing listed emergency contacts of a patient's whereabouts 226
pursuant to s. 119.0712(2)(d). The report and certificate shall 227
be made a part of the patient's clinical record. Any facility 228
accepting the patient based on this certificate must send a copy 229
of the certificate t o the department within 5 working days. The 230
document may be submitted electronically through existing data 231
systems, if applicable. 232
233
When sending the order, report, or certificate to the 234
department, a facility shall, at a minimum, provide information 235
about which action was taken regarding the patient under 236
paragraph (g), which information shall also be made a part of 237
the patient's clinical record. 238
(e) The department shall receive and maintain the copies 239
of ex parte orders, involuntary outpatient services orders 240
issued pursuant to ss. 394.4655 and 394.467 s. 394.4655, 241
involuntary inpatient placement orders issued pursuant to s. 242
394.467, professional certificates, law enforcement officers' 243
reports, and reports relating to the transportation of patients. 244
These documents shall be considered part of the clinical record, 245
governed by the provisions of s. 394.4615. These documents shall 246
be used to prepare annual reports analyzing the data obtained 247
from these documents, without including the personal identifying 248
information of the patient. The department identifying patients, 249
and shall post the reports on its website and provide copies of 250
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
such reports to the department, the President of the Senate, the 251
Speaker of the House of Representatives, and the minority 252
leaders of the Senate and the House of Representatives by 253
November 30 of each year . 254
(f) A patient shall be examined by a physician or a 255
clinical psychologist, or by a psychiatric nurse performing 256
within the framework of an established protocol with a 257
psychiatrist at a facility without unnecessary delay to 258
determine if the criteria for involuntary services are met. 259
Emergency treatment may be provided upon the order of a 260
physician if the physician determines that such treatment is 261
necessary for the safety of the pa tient or others. The patient 262
may not be released by the receiving facility or its contractor 263
without the documented approval of a psychiatrist or a clinical 264
psychologist or, if the receiving facility is owned or operated 265
by a hospital, health system, or na tionally accredited community 266
mental health center, the release may also be approved by a 267
psychiatric nurse performing within the framework of an 268
established protocol with a psychiatrist, or an attending 269
emergency department physician with experience in th e diagnosis 270
and treatment of mental illness after completion of an 271
involuntary examination pursuant to this subsection. A 272
psychiatric nurse may not approve the release of a patient if 273
the involuntary examination was initiated by a psychiatrist 274
unless the release is approved by the initiating psychiatrist. 275
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
The release may be approved through telehealth. 276
(g) The examination period must be for up to 72 hours and 277
begins when a patient arrives at the receiving facility . For a 278
minor, the examination shall be in itiated within 12 hours after 279
the patient's arrival at the facility. Within the examination 280
period, one of the following actions must be taken, based on the 281
individual needs of the patient: 282
1. The patient shall be released, unless he or she is 283
charged with a crime, in which case the patient shall be 284
returned to the custody of a law enforcement officer; 285
2. The patient shall be released, subject to subparagraph 286
1., for voluntary outpatient treatment; 287
3. The patient, unless he or she is charged with a cr ime, 288
shall be asked to give express and informed consent to placement 289
as a voluntary patient and, if such consent is given, the 290
patient shall be admitted as a voluntary patient; or 291
4. A petition for involuntary services shall be filed in 292
the circuit court if inpatient treatment is deemed necessary or 293
with the criminal county court, as defined in s. 394.4655(1), as 294
applicable. When inpatient treatment is deemed necessary, the 295
least restrictive treatment consistent with the optimum 296
improvement of the patien t's condition shall be made available. 297
The When a petition is to be filed for involuntary outpatient 298
placement, it shall be filed by one of the petitioners specified 299
in s. 394.467, and the court shall dismiss an untimely filed 300
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
petition s. 394.4655(4)(a). A petition for involuntary inpatient 301
placement shall be filed by the facility administrator. If a 302
patient's 72-hour examination period ends on a weekend or 303
holiday, including the hours before the ordinary business hours 304
on the morning of the next working day, and the receiving 305
facility: 306
a. Intends to file a petition for involuntary services, 307
such patient may be held at the a receiving facility through the 308
next working day thereafter and the such petition for 309
involuntary services must be filed no later th an such date. If 310
the receiving facility fails to file the a petition by for 311
involuntary services at the ordinary close of business on the 312
next working day, the patient shall be released from the 313
receiving facility following approval pursuant to paragraph ( f). 314
b. Does not intend to file a petition for involuntary 315
services, the a receiving facility may postpone release of a 316
patient until the next working day thereafter only if a 317
qualified professional documents that adequate discharge 318
planning and procedure s in accordance with s. 394.468, and 319
approval pursuant to paragraph (f), are not possible until the 320
next working day. 321
(h) A person for whom an involuntary examination has been 322
initiated who is being evaluated or treated at a hospital for an 323
emergency medical condition specified in s. 395.002 must be 324
examined by a facility within the examination period specified 325
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
in paragraph (g). The examination period begins when the patient 326
arrives at the hospital and ceases when the attending physician 327
documents that the patient has an emergency medical condition. 328
If the patient is examined at a hospital providing emergency 329
medical services by a professional qualified to perform an 330
involuntary examination and is found as a result of that 331
examination not to meet the criteria for involuntary outpatient 332
services pursuant to s. 394.467 s. 394.4655(2) or involuntary 333
inpatient placement pursua nt to s. 394.467(1), the patient may 334
be offered voluntary outpatient or inpatient services or 335
placement, if appropriate, or released directly from the 336
hospital providing emergency medical services. The finding by 337
the professional that the patient has been examined and does not 338
meet the criteria for involuntary inpatient services or 339
involuntary outpatient placement must be entered into the 340
patient's clinical record. This paragraph is not intended to 341
prevent a hospital providing emergency medical services fro m 342
appropriately transferring a patient to another hospital before 343
stabilization if the requirements of s. 395.1041(3)(c) have been 344
met. 345
Section 4. Section 394.4655, Florida Statutes, is amended 346
to read: 347
394.4655 Involuntary outpatient services. — 348
(1) DEFINITIONS.—As used in this section, the term: 349
(a) "Court" means a circuit court or a criminal county 350
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
court. 351
(b) "Criminal county court" means a county court 352
exercising its original jurisdiction in a misdemeanor case under 353
s. 34.01. 354
(c) "Involuntary outpatient placement" means involuntary 355
outpatient services as defined in s. 394.467. 356
(2) A criminal county court may order an individual to 357
involuntary outpatient placement under s. 394.467. CRITERIA FOR 358
INVOLUNTARY OUTPATIENT SERVICES. —A person may be ordered to 359
involuntary outpatient services upon a finding of the court, by 360
clear and convincing evidence, that the person meets all of the 361
following criteria: 362
(a) The person is 18 years of age or older. 363
(b) The person has a mental illness. 364
(c) The person is unlikely to survive safely in the 365
community without supervision, based on a clinical 366
determination. 367
(d) The person has a history of lack of compliance with 368
treatment for mental illness. 369
(e) The person has: 370
1. At least twice within the imme diately preceding 36 371
months been involuntarily admitted to a receiving or treatment 372
facility as defined in s. 394.455, or has received mental health 373
services in a forensic or correctional facility. The 36 -month 374
period does not include any period during whi ch the person was 375
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admitted or incarcerated; or 376
2. Engaged in one or more acts of serious violent behavior 377
toward self or others, or attempts at serious bodily harm to 378
himself or herself or others, within the preceding 36 months. 379
(f) The person is, as a result of his or her mental 380
illness, unlikely to voluntarily participate in the recommended 381
treatment plan and has refused voluntary services for treatment 382
after sufficient and conscientious explanation and disclosure of 383
why the services are necessary or is unable to determine for 384
himself or herself whether services are necessary. 385
(g) In view of the person's treatment history and current 386
behavior, the person is in need of involuntary outpatient 387
services in order to prevent a relapse or deterioration that 388
would be likely to result in serious bodily harm to himself or 389
herself or others, or a substantial harm to his or her well -390
being as set forth in s. 394.463(1). 391
(h) It is likely that the person will benefit from 392
involuntary outpatient services. 393
(i) All available, less restrictive alternatives that 394
would offer an opportunity for improvement of his or her 395
condition have been judged to be inappropriate or unavailable. 396
(3) INVOLUNTARY OUTPATIENT SERVICES. — 397
(a)1. A patient who is being recommended for in voluntary 398
outpatient services by the administrator of the facility where 399
the patient has been examined may be retained by the facility 400
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after adherence to the notice procedures provided in s. 401
394.4599. The recommendation must be supported by the opinion of 402
a psychiatrist and the second opinion of a clinical psychologist 403
or another psychiatrist, both of whom have personally examined 404
the patient within the preceding 72 hours, that the criteria for 405
involuntary outpatient services are met. However, if the 406
administrator certifies that a psychiatrist or clinical 407
psychologist is not available to provide the second opinion, the 408
second opinion may be provided by a licensed physician who has 409
postgraduate training and experience in diagnosis and treatment 410
of mental illness, a physician assistant who has at least 3 411
years' experience and is supervised by such licensed physician 412
or a psychiatrist, a clinical social worker, or by a psychiatric 413
nurse. Any second opinion authorized in this subparagraph may be 414
conducted through a face-to-face examination, in person or by 415
electronic means. Such recommendation must be entered on an 416
involuntary outpatient services certificate that authorizes the 417
facility to retain the patient pending completion of a hearing. 418
The certificate must be made a part of the patient's clinical 419
record. 420
2. If the patient has been stabilized and no longer meets 421
the criteria for involuntary examination pursuant to s. 422
394.463(1), the patient must be released from the facility while 423
awaiting the hearing for inv oluntary outpatient services. Before 424
filing a petition for involuntary outpatient services, the 425
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administrator of the facility or a designated department 426
representative must identify the service provider that will have 427
primary responsibility for service pro vision under an order for 428
involuntary outpatient services, unless the person is otherwise 429
participating in outpatient psychiatric treatment and is not in 430
need of public financing for that treatment, in which case the 431
individual, if eligible, may be ordered to involuntary treatment 432
pursuant to the existing psychiatric treatment relationship. 433
3. The service provider shall prepare a written proposed 434
treatment plan in consultation with the patient or the patient's 435
guardian advocate, if appointed, for the cour t's consideration 436
for inclusion in the involuntary outpatient services order that 437
addresses the nature and extent of the mental illness and any 438
co-occurring substance use disorder that necessitate involuntary 439
outpatient services. The treatment plan must sp ecify the likely 440
level of care, including the use of medication, and anticipated 441
discharge criteria for terminating involuntary outpatient 442
services. Service providers may select and supervise other 443
individuals to implement specific aspects of the treatment plan. 444
The services in the plan must be deemed clinically appropriate 445
by a physician, clinical psychologist, psychiatric nurse, mental 446
health counselor, marriage and family therapist, or clinical 447
social worker who consults with, or is employed or contracte d 448
by, the service provider. The service provider must certify to 449
the court in the proposed plan whether sufficient services for 450
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improvement and stabilization are currently available and 451
whether the service provider agrees to provide those services. 452
If the service provider certifies that the services in the 453
proposed treatment plan are not available, the petitioner may 454
not file the petition. The service provider must notify the 455
managing entity if the requested services are not available. The 456
managing entity must document such efforts to obtain the 457
requested services. 458
(b) If a patient in involuntary inpatient placement meets 459
the criteria for involuntary outpatient services, the 460
administrator of the facility may, before the expiration of the 461
period during which the facility is authorized to retain the 462
patient, recommend involuntary outpatient services. The 463
recommendation must be supported by the opinion of a 464
psychiatrist and the second opinion of a clinical psychologist 465
or another psychiatrist, both of whom hav e personally examined 466
the patient within the preceding 72 hours, that the criteria for 467
involuntary outpatient services are met. However, if the 468
administrator certifies that a psychiatrist or clinical 469
psychologist is not available to provide the second opin ion, the 470
second opinion may be provided by a licensed physician who has 471
postgraduate training and experience in diagnosis and treatment 472
of mental illness, a physician assistant who has at least 3 473
years' experience and is supervised by such licensed physici an 474
or a psychiatrist, a clinical social worker, or by a psychiatric 475
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nurse. Any second opinion authorized in this subparagraph may be 476
conducted through a face -to-face examination, in person or by 477
electronic means. Such recommendation must be entered on an 478
involuntary outpatient services certificate, and the certificate 479
must be made a part of the patient's clinical record. 480
(c)1. The administrator of the treatment facility shall 481
provide a copy of the involuntary outpatient services 482
certificate and a copy of the state mental health discharge form 483
to the managing entity in the county where the patient will be 484
residing. For persons who are leaving a state mental health 485
treatment facility, the petition for involuntary outpatient 486
services must be filed in the coun ty where the patient will be 487
residing. 488
2. The service provider that will have primary 489
responsibility for service provision shall be identified by the 490
designated department representative before the order for 491
involuntary outpatient services and must, befo re filing a 492
petition for involuntary outpatient services, certify to the 493
court whether the services recommended in the patient's 494
discharge plan are available and whether the service provider 495
agrees to provide those services. The service provider must 496
develop with the patient, or the patient's guardian advocate, if 497
appointed, a treatment or service plan that addresses the needs 498
identified in the discharge plan. The plan must be deemed to be 499
clinically appropriate by a physician, clinical psychologist, 500
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psychiatric nurse, mental health counselor, marriage and family 501
therapist, or clinical social worker, as defined in this 502
chapter, who consults with, or is employed or contracted by, the 503
service provider. 504
3. If the service provider certifies that the services in 505
the proposed treatment or service plan are not available, the 506
petitioner may not file the petition. The service provider must 507
notify the managing entity if the requested services are not 508
available. The managing entity must document such efforts to 509
obtain the requested services. 510
(4) PETITION FOR INVOLUNTARY OUTPATIENT SERVICES. — 511
(a) A petition for involuntary outpatient services may be 512
filed by: 513
1. The administrator of a receiving facility; or 514
2. The administrator of a treatment facility. 515
(b) Each required criterion for involuntary outpatient 516
services must be alleged and substantiated in the petition for 517
involuntary outpatient services. A copy of the certificate 518
recommending involuntary outpatient services completed by a 519
qualified professional specified in subsection (3) must be 520
attached to the petition. A copy of the proposed treatment plan 521
must be attached to the petition. Before the petition is filed, 522
the service provider shall certify that the services in the 523
proposed plan are available . If the necessary services are not 524
available, the petition may not be filed. The service provider 525
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must notify the managing entity if the requested services are 526
not available. The managing entity must document such efforts to 527
obtain the requested services. 528
(c) The petition for involuntary outpatient services must 529
be filed in the county where the patient is located, unless the 530
patient is being placed from a state treatment facility, in 531
which case the petition must be filed in the county where the 532
patient will reside. When the petition has been filed, the clerk 533
of the court shall provide copies of the petition and the 534
proposed treatment plan to the department, the managing entity, 535
the patient, the patient's guardian or representative, the state 536
attorney, and the public defender or the patient's private 537
counsel. A fee may not be charged for filing a petition under 538
this subsection. 539
(5) APPOINTMENT OF COUNSEL. —Within 1 court working day 540
after the filing of a petition for involuntary outpatient 541
services, the court shall appoint the public defender to 542
represent the person who is the subject of the petition, unless 543
the person is otherwise represented by counsel. The clerk of the 544
court shall immediately notify the public defender of the 545
appointment. The public defe nder shall represent the person 546
until the petition is dismissed, the court order expires, or the 547
patient is discharged from involuntary outpatient services. An 548
attorney who represents the patient must be provided access to 549
the patient, witnesses, and recor ds relevant to the presentation 550
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of the patient's case and shall represent the interests of the 551
patient, regardless of the source of payment to the attorney. 552
(6) CONTINUANCE OF HEARING. —The patient is entitled, with 553
the concurrence of the patient's counse l, to at least one 554
continuance of the hearing. The continuance shall be for a 555
period of up to 4 weeks. 556
(7) HEARING ON INVOLUNTARY OUTPATIENT SERVICES. — 557
(a)1. The court shall hold the hearing on involuntary 558
outpatient services within 5 working days afte r the filing of 559
the petition, unless a continuance is granted. The hearing must 560
be held in the county where the petition is filed, must be as 561
convenient to the patient as is consistent with orderly 562
procedure, and must be conducted in physical settings not likely 563
to be injurious to the patient's condition. If the court finds 564
that the patient's attendance at the hearing is not consistent 565
with the best interests of the patient and if the patient's 566
counsel does not object, the court may waive the presence of th e 567
patient from all or any portion of the hearing. The state 568
attorney for the circuit in which the patient is located shall 569
represent the state, rather than the petitioner, as the real 570
party in interest in the proceeding. 571
2. The court may appoint a magist rate to preside at the 572
hearing. One of the professionals who executed the involuntary 573
outpatient services certificate shall be a witness. The patient 574
and the patient's guardian or representative shall be informed 575
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by the court of the right to an independent expert examination. 576
If the patient cannot afford such an examination, the court 577
shall ensure that one is provided, as otherwise provided by law. 578
The independent expert's report is confidential and not 579
discoverable, unless the expert is to be called as a w itness for 580
the patient at the hearing. The court shall allow testimony from 581
individuals, including family members, deemed by the court to be 582
relevant under state law, regarding the person's prior history 583
and how that prior history relates to the person's c urrent 584
condition. The testimony in the hearing must be given under 585
oath, and the proceedings must be recorded. The patient may 586
refuse to testify at the hearing. 587
(b)1. If the court concludes that the patient meets the 588
criteria for involuntary outpatient s ervices pursuant to 589
subsection (2), the court shall issue an order for involuntary 590
outpatient services. The court order shall be for a period of up 591
to 90 days. The order must specify the nature and extent of the 592
patient's mental illness. The order of the c ourt and the 593
treatment plan must be made part of the patient's clinical 594
record. The service provider shall discharge a patient from 595
involuntary outpatient services when the order expires or any 596
time the patient no longer meets the criteria for involuntary 597
placement. Upon discharge, the service provider shall send a 598
certificate of discharge to the court. 599
2. The court may not order the department or the service 600
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provider to provide services if the program or service is not 601
available in the patient's local co mmunity, if there is no space 602
available in the program or service for the patient, or if 603
funding is not available for the program or service. The service 604
provider must notify the managing entity if the requested 605
services are not available. The managing ent ity must document 606
such efforts to obtain the requested services. A copy of the 607
order must be sent to the managing entity by the service 608
provider within 1 working day after it is received from the 609
court. The order may be submitted electronically through 610
existing data systems. After the order for involuntary services 611
is issued, the service provider and the patient may modify the 612
treatment plan. For any material modification of the treatment 613
plan to which the patient or, if one is appointed, the patient's 614
guardian advocate agrees, the service provider shall send notice 615
of the modification to the court. Any material modifications of 616
the treatment plan which are contested by the patient or the 617
patient's guardian advocate, if applicable, must be approved or 618
disapproved by the court consistent with subsection (3). 619
3. If, in the clinical judgment of a physician, the 620
patient has failed or has refused to comply with the treatment 621
ordered by the court, and, in the clinical judgment of the 622
physician, efforts were made to solicit compliance and the 623
patient may meet the criteria for involuntary examination, a 624
person may be brought to a receiving facility pursuant to s. 625
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
394.463. If, after examination, the patient does not meet the 626
criteria for involuntary inpatient placeme nt pursuant to s. 627
394.467, the patient must be discharged from the facility. The 628
involuntary outpatient services order shall remain in effect 629
unless the service provider determines that the patient no 630
longer meets the criteria for involuntary outpatient se rvices or 631
until the order expires. The service provider must determine 632
whether modifications should be made to the existing treatment 633
plan and must attempt to continue to engage the patient in 634
treatment. For any material modification of the treatment plan 635
to which the patient or the patient's guardian advocate, if 636
applicable, agrees, the service provider shall send notice of 637
the modification to the court. Any material modifications of the 638
treatment plan which are contested by the patient or the 639
patient's guardian advocate, if applicable, must be approved or 640
disapproved by the court consistent with subsection (3). 641
(c) If, at any time before the conclusion of the initial 642
hearing on involuntary outpatient services, it appears to the 643
court that the person does not meet the criteria for involuntary 644
outpatient services under this section but, instead, meets the 645
criteria for involuntary inpatient placement, the court may 646
order the person admitted for involuntary inpatient examination 647
under s. 394.463. If the perso n instead meets the criteria for 648
involuntary assessment, protective custody, or involuntary 649
admission pursuant to s. 397.675, the court may order the person 650
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to be admitted for involuntary assessment for a period of 5 days 651
pursuant to s. 397.6811. Thereafte r, all proceedings are 652
governed by chapter 397. 653
(d) At the hearing on involuntary outpatient services, the 654
court shall consider testimony and evidence regarding the 655
patient's competence to consent to services. If the court finds 656
that the patient is incom petent to consent to treatment, it 657
shall appoint a guardian advocate as provided in s. 394.4598. 658
The guardian advocate shall be appointed or discharged in 659
accordance with s. 394.4598. 660
(e) The administrator of the receiving facility or the 661
designated department representative shall provide a copy of the 662
court order and adequate documentation of a patient's mental 663
illness to the service provider for involuntary outpatient 664
services. Such documentation must include any advance directives 665
made by the patient, a psychiatric evaluation of the patient, 666
and any evaluations of the patient performed by a psychologist 667
or a clinical social worker. 668
(8) PROCEDURE FOR CONTINUED INVOLUNTARY OUTPATIENT 669
SERVICES.— 670
(a)1. If the person continues to meet the criteria for 671
involuntary outpatient services, the service provider shall, at 672
least 10 days before the expiration of the period during which 673
the treatment is ordered for the person, file in the court that 674
issued the order for involuntary outpatient services a petition 675
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for continued involuntary outpatient services. The court shall 676
immediately schedule a hearing on the petition to be held within 677
15 days after the petition is filed. 678
2. The existing involuntary outpatient services order 679
remains in effect until disposition on the petition for 680
continued involuntary outpatient services. 681
3. A certificate shall be attached to the petition which 682
includes a statement from the person's physician or clinical 683
psychologist justifying the request, a brief description of the 684
patient's treatment during the time he or she was receiving 685
involuntary services, and an individualized plan of continued 686
treatment. 687
4. The service provider shall develop the individualized 688
plan of continued treatment in consultation with the patient or 689
the patient's guardian advocate, if applicable. When the 690
petition has been filed, the clerk of the court shall provide 691
copies of the certificate and the individualized plan of 692
continued services to the department, the patient, the patient's 693
guardian advocate, the sta te attorney, and the patient's private 694
counsel or the public defender. 695
(b) Within 1 court working day after the filing of a 696
petition for continued involuntary outpatient services, the 697
court shall appoint the public defender to represent the person 698
who is the subject of the petition, unless the person is 699
otherwise represented by counsel. The clerk of the court shall 700
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immediately notify the public defender of such appointment. The 701
public defender shall represent the person until the petition is 702
dismissed or the court order expires or the patient is 703
discharged from involuntary outpatient services. Any attorney 704
representing the patient shall have access to the patient, 705
witnesses, and records relevant to the presentation of the 706
patient's case and shall represent the interests of the patient, 707
regardless of the source of payment to the attorney. 708
(c) Hearings on petitions for continued involuntary 709
outpatient services must be before the court that issued the 710
order for involuntary outpatient services. The court may appoint 711
a magistrate to preside at the hearing. The procedures for 712
obtaining an order pursuant to this paragraph must meet the 713
requirements of subsection (7), except that the time period 714
included in paragraph (2)(e) is not applicable in determining 715
the appropriateness of additional periods of involuntary 716
outpatient placement. 717
(d) Notice of the hearing must be provided as set forth in 718
s. 394.4599. The patient and the patient's attorney may agree to 719
a period of continued outpatient services without a court 720
hearing. 721
(e) The same procedure must be repeated before the 722
expiration of each additional period the patient is placed in 723
treatment. 724
(f) If the patient has previously been found incompetent 725
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to consent to treatment, the court shall consider testimony an d 726
evidence regarding the patient's competence. Section 394.4598 727
governs the discharge of the guardian advocate if the patient's 728
competency to consent to treatment has been restored. 729
Section 5. Section 394.467, Florida Statutes, is amended 730
to read: 731
394.467 Involuntary services inpatient placement.— 732
(1) DEFINITIONS.—As used in this section, the term: 733
(a) "Court" means a circuit court. 734
(b) "Involuntary inpatient placement" means services 735
provided on an inpatient basis to a person 18 years of age or 736
older who does not voluntarily consent to services under this 737
chapter or a minor who does not voluntarily assent to services 738
under this chapter. 739
(c) "Involuntary outpatient services" means services 740
provided on an outpatient basis to a person who does no t 741
voluntarily consent to services under this chapter. 742
(2)(1) CRITERIA FOR INVOLUNTARY SERVICES .—A person may be 743
ordered by a court to be provided for involuntary services 744
inpatient placement for treatment upon a finding of the court , 745
by clear and convinc ing evidence, that the person meets the 746
following criteria: 747
(a) The person He or she has a mental illness and because 748
of his or her mental illness: 749
1.a. Is unlikely to voluntarily participate in the 750
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recommended treatment plan and has refused voluntary services or 751
He or she has refused voluntary inpatient placement for 752
treatment after sufficient and conscientious explanation and 753
disclosure of the purpose of inpatient placement for treatment; 754
or 755
b. He or she Is unable to determine for himself or herself 756
whether services or inpatient placement is necessary; and 757
2.a. Is unlikely to survive safely in the community 758
without supervision, based on clinical determination; 759
b.2.a. He or she Is incapable of surviving alone or with 760
the help of willing, able, and responsible family or friends, 761
including available alternative services, and, without 762
treatment, is likely to suffer from neglect or refuse to care 763
for himself or herself, and such neglect or refusal poses a real 764
and present threat of substantial harm to his or her well-being; 765
or 766
c.b. Without treatment, there is a substantial likelihood 767
that in the near future the person he or she will inflict 768
serious bodily harm on self or others, as evidenced by recent 769
behavior causing, attempting to cause, or threatening to cause 770
such harm.; and 771
(b) In view of the person's treatment history and current 772
behavior, the person is in need of involuntary outpatient 773
services to prevent a relapse or deterioration of his or her 774
mental health that would be likely to result in serious bodily 775
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harm to self or others, or a substantial harm to his or her 776
well-being as set forth in s. 394.463(1). 777
(c) The person has a history of lack of compliance with 778
treatment for mental illness. 779
(d) It is likely that the person will benefit fro m 780
involuntary services. 781
(e)(b) All available less restrictive treatment 782
alternatives that would offer an opportunity for improvement of 783
the person's his or her condition have been deemed judged to be 784
inappropriate or unavailable. 785
(3)(2) RECOMMENDATION FOR INVOLUNTARY SERVICES AND 786
ADMISSION TO A TREATMENT FACILITY.—A patient may be recommended 787
for involuntary inpatient placement, involuntary outpatient 788
services, or a combination of both. 789
(a) A patient may be retained by a facility for 790
involuntary services or involuntarily placed in a treatment 791
facility upon the recommendation of the administrator of the 792
facility where the patient has been examined and after adherence 793
to the notice and hearing procedures provided in s. 394.4599. 794
However, if a patient who is being recommended for only 795
involuntary outpatient services has been stabilized and no 796
longer meets the criteria for involuntary examination pursuant 797
to s. 394.463(1), the patient must be released from the facility 798
while awaiting the hearing for involun tary outpatient services. 799
(b) The recommendation must be supported by the opinion of 800
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a psychiatrist and the second opinion of a clinical psychologist 801
or another psychiatrist, both of whom have personally examined 802
the patient within the preceding 72 hours , that the criteria for 803
involuntary services inpatient placement are met. 804
(c) If However, if the administrator certifies that a 805
psychiatrist or clinical psychologist is not available to 806
provide a the second opinion, the administrator must certify 807
that a clinical psychologist is not available and the second 808
opinion may be provided by a licensed physician who has 809
postgraduate training and experience in diagnosis and treatment 810
of mental illness or by a psychiatric nurse. If the patient is 811
being recommended for involuntary outpatient services only, the 812
second opinion may be provided by a physician assistant who has 813
at least 3 years' experience and is supervised by a licensed 814
physician or psychiatrist or a clinical social worker. 815
(d) Any opinion authorized i n this subsection may be 816
conducted through a face -to-face or in-person examination, in 817
person, or by electronic means. Recommendations for involuntary 818
services must Such recommendation shall be entered on an a 819
petition for involuntary services inpatient placement 820
certificate, which shall be made a part of the patient's 821
clinical record. The certificate must either authorize the 822
facility to retain the patient pending completion of a hearing 823
or authorize that authorizes the facility to retain the patient 824
pending transfer to a treatment facility or completion of a 825
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
hearing. 826
(4)(3) PETITION FOR INVOLUNTARY SERVICES INPATIENT 827
PLACEMENT.— 828
(a) A petition for involuntary services may be filed by: 829
1. The administrator of a receiving the facility; or 830
2. The administrator of a treatment facility. 831
(b) shall file A petition for involuntary inpatient 832
placement, or inpatient placement followed by outpatient 833
services, must be filed in the court in the county where the 834
patient is located. 835
(c) A petition for involunt ary outpatient services must be 836
filed in the county where the patient is located, unless the 837
patient is being placed from a state treatment facility, in 838
which case the petition must be filed in the county where the 839
patient will reside. 840
(d)1. The petitioner must state in the petition: 841
a. Whether the petitioner is recommending inpatient 842
placement, outpatient services, or both. 843
b. The length of time recommended for each type of 844
involuntary services. 845
c. The reasons for the recommendation. 846
2. If recommending involuntary outpatient services, or a 847
combination of involuntary inpatient placement and involuntary 848
outpatient services, the petitioner must identify the service 849
provider that will have primary responsibility for providing 850
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such services under an or der for involuntary outpatient 851
services, unless the person is otherwise participating in 852
outpatient psychiatric treatment and is not in need of public 853
financing for that treatment, in which case the individual, if 854
eligible, may be ordered to involuntary tr eatment pursuant to 855
the existing psychiatric treatment relationship. 856
3. If recommending an immediate order to involuntary 857
outpatient placement, the service provider shall prepare a 858
written proposed treatment plan in consultation with the patient 859
or the patient's guardian advocate, if appointed, for the 860
court's consideratio n for inclusion in the involuntary 861
outpatient services order that addresses the nature and extent 862
of the mental illness and any co -occurring substance use 863
disorder that necessitate involuntary outpatient services. The 864
treatment plan must specify the likely level of care, including 865
the use of medication, and anticipated discharge criteria for 866
terminating involuntary outpatient services. Service providers 867
may select and supervise other individuals to implement specific 868
aspects of the treatment plan. The servi ces in the plan must be 869
deemed clinically appropriate by a physician, clinical 870
psychologist, psychiatric nurse, mental health counselor, 871
marriage and family therapist, or clinical social worker who 872
consults with, or is employed or contracted by, the servic e 873
provider. The service provider must certify to the court in the 874
proposed plan whether sufficient services for improvement and 875
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stabilization are currently available and whether the service 876
provider agrees to provide those services. If the service 877
provider certifies that the services in the proposed treatment 878
plan are not available, the petitioner may not file the 879
petition. The service provider must notify the managing entity 880
if the requested services are not available. The managing entity 881
must document such efforts to obtain the requested services. 882
(e) Each required criterion for the recommended 883
involuntary services must be alleged and substantiated in the 884
petition. A copy of the certificate recommending involuntary 885
services completed by a qualified profe ssional specified in 886
subsection (3) and, if applicable, a copy of the proposed 887
treatment plan must be attached to the petition. 888
(f) When the petition has been filed Upon filing, the 889
clerk of the court shall provide copies of the petition and, if 890
applicable, the proposed treatment plan to the department, the 891
managing entity, the patient, the patient's guardian or 892
representative, and the state attorney, and the public defender 893
or the patient's private counsel of the judicial circuit in 894
which the patient is located. A fee may not be charged for the 895
filing of a petition under this subsection. 896
(5)(4) APPOINTMENT OF COUNSEL. —Within 1 court working day 897
after the filing of a petition for involuntary services 898
inpatient placement, the court shall appoint the publi c defender 899
to represent the person who is the subject of the petition, 900
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unless the person is otherwise represented by counsel or 901
ineligible. The clerk of the court shall immediately notify the 902
public defender of such appointment. The public defender shall 903
represent the person until the petition is dismissed, the court 904
order expires, or the patient is discharged from involuntary 905
services. Any attorney who represents representing the patient 906
shall be provided have access to the patient, witnesses, and 907
records relevant to the presentation of the patient's case and 908
shall represent the interests of the patient, regardless of the 909
source of payment to the attorney. 910
(6)(5) CONTINUANCE OF HEARING. —The patient and the state 911
are independently is entitled, with the concurrence of the 912
patient's counsel, to at least one continuance of the hearing . 913
The patient's continuance may be for a period of up to 4 weeks 914
and requires the concurrence of the patient's counsel. The 915
state's continuance may be for a period of up to 5 cou rt working 916
days and requires a showing of good cause and due diligence by 917
the state before requesting the continuance. The state's failure 918
to timely review any readily available document or failure to 919
attempt to contact a known witness does not warrant a 920
continuance. 921
(7)(6) HEARING ON INVOLUNTARY SERVICES INPATIENT 922
PLACEMENT.— 923
(a)1. The court shall hold a the hearing on the 924
involuntary services petition inpatient placement within 5 court 925
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working days after the filing of the petition , unless a 926
continuance is granted. 927
2. The court must hold any hearing on involuntary 928
outpatient services in the county where the petition is filed. A 929
hearing on involuntary inpatient placement, or a combination of 930
involuntary inpatient placement and involuntary outpatient 931
services Except for good cause documented in the court file , the 932
hearing must be held in the county or the facility, as 933
appropriate, where the patient is located, except for good cause 934
documented in the court file. 935
3. A hearing on involuntary services must be as convenient 936
to the patient as is consistent with orderly procedure, and 937
shall be conducted in physical settings not likely to be 938
injurious to the patient's condition. If the court finds that 939
the patient's attendance at the hearing is not consistent w ith 940
the best interests of the patient, or the patient knowingly, 941
intelligently, and voluntarily waives his or her right to be 942
present, and if the patient's counsel does not object, the court 943
may waive the attendance presence of the patient from all or any 944
portion of the hearing. The state attorney for the circuit in 945
which the patient is located shall represent the state, rather 946
than the petitioner, as the real party in interest in the 947
proceeding. The facility shall make the respondent's clinical 948
records available to the state attorney and the respondent's 949
attorney so that the state can evaluate and prepare its case. 950
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However, these records shall remain confidential, and the state 951
attorney may not use any record obtained under this part for 952
criminal investigation or prosecution purposes, or for any 953
purpose other than the patient's civil commitment under this 954
chapter petitioning facility administrator, as the real party in 955
interest in the proceeding . 956
(b)3. The court may appoint a magistrate to preside at the 957
hearing on the petition and any ancillary proceedings, 958
including, but not limited to, writs of habeas corpus issued 959
pursuant to s. 394.459. Upon a finding of good cause, the court 960
may permit all witnesses, including, but not limited to, medical 961
professionals who are or have been involved with the patient's 962
treatment, to remotely attend and testify at the hearing under 963
oath via audio-video teleconference. A witness intending to 964
remotely attend and testify must provide the parties with all 965
relevant documents b y the close of business on the day before 966
the hearing. One of the professionals who executed the petition 967
for involuntary services inpatient placement certificate shall 968
be a witness. The patient and the patient's guardian or 969
representative shall be informe d by the court of the right to an 970
independent expert examination. If the patient cannot afford 971
such an examination, the court shall ensure that one is 972
provided, as otherwise provided for by law. The independent 973
expert's report is confidential and not disco verable, unless the 974
expert is to be called as a witness for the patient at the 975
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hearing. The court shall allow testimony from persons, including 976
family members, deemed by the court to be relevant under state 977
law, regarding the person's prior history and how that prior 978
history relates to the person's current condition. The testimony 979
in the hearing must be given under oath, and the proceedings 980
must be recorded. The patient may refuse to testify at the 981
hearing. 982
(c)(b) At the hearing, the court shall consider testimony 983
and evidence regarding the patient's competence to consent to 984
services and treatment. If the court finds that the patient is 985
incompetent to consent to treatment, it shall appoint a guardian 986
advocate as provided in s. 394.4598. 987
(8) ORDERS OF THE COURT.— 988
(a)1. If the court concludes that the patient meets the 989
criteria for involuntary services, the court may order a patient 990
to involuntary inpatient placement, involuntary outpatient 991
services, or a combination of involuntary services depending on 992
the criteria met and which type of involuntary services best 993
meet the needs of the patient. However, if the court orders the 994
patient to involuntary outpatient services, the court may not 995
order the department or the service provider to provide services 996
if the program or service is not available in the patient's 997
local community, if there is no space available in the program 998
or service for the patient, or if funding is not available for 999
the program or service. The service provider must notify the 1000
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managing entity if the requested services are not available. The 1001
managing entity must document such efforts to obtain the 1002
requested services. A copy of the order must be sent to the 1003
managing entity by the service provider within 1 working day 1004
after it is received from t he court. 1005
2. The order must specify the nature and extent of the 1006
patient's mental illness. 1007
3.a. An order for only involuntary outpatient services 1008
shall be for a period of up to 90 days. 1009
b. An order for involuntary inpatient placement, 1010
involuntary outpatient services, or a combination of involuntary 1011
services may be for up to 6 months. 1012
4. An order for a combination of involuntary services 1013
shall specify the length of time the patient shall be ordered 1014
for involuntary inpatient placement and involunta ry outpatient 1015
services. 1016
5. The order of the court and the patient's treatment 1017
plan, if applicable, must be made part of the patient's clinical 1018
record. 1019
(b) If the court orders a patient into involuntary 1020
inpatient placement, the court it may order that the patient be 1021
transferred to a treatment facility , or, if the patient is at a 1022
treatment facility, that the patient be retained there or be 1023
treated at any other appropriate facility, or that the patient 1024
receive services, on an involuntary basis , for up to 90 days. 1025
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However, any order for involuntary mental health services in a 1026
treatment facility may be for up to 6 months. The order shall 1027
specify the nature and extent of the patient's mental illness. 1028
The court may not order an individual with a developmental 1029
disability as defined in s. 393.063 or a traumatic brain injury 1030
or dementia who lacks a co -occurring mental illness to be 1031
involuntarily placed in a state treatment facility. The facility 1032
shall discharge a patient any time the patient no longer meets 1033
the criteria for involuntary inpatient placement, unless the 1034
patient has transferred to voluntary status. 1035
(c) If at any time before the conclusion of a the hearing 1036
on involuntary services inpatient placement it appears to the 1037
court that the patient person does not meet the criteria for 1038
involuntary inpatient placement under this section, but instead 1039
meets the criteria for involuntary outpatient services, the 1040
court may order the person evaluated for involuntary outpatient 1041
services pursuant to s. 394.4655. The peti tion and hearing 1042
procedures set forth in s. 394.4655 shall apply. If the person 1043
instead meets the criteria for involuntary assessment, 1044
protective custody, or involuntary admission or treatment 1045
pursuant to s. 397.675, then the court may order the person to 1046
be admitted for involuntary assessment for a period of 5 days 1047
pursuant to s. 397.677 s. 397.6811. Thereafter, all proceedings 1048
are governed by chapter 397. 1049
(d) At the hearing on involuntary inpatient placement, the 1050
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court shall consider testimony and evide nce regarding the 1051
patient's competence to consent to treatment. If the court finds 1052
that the patient is incompetent to consent to treatment, it 1053
shall appoint a guardian advocate as provided in s. 394.4598. 1054
(d)(e) The administrator of the petitioning facil ity or 1055
the designated department representative shall provide a copy of 1056
the court order and adequate documentation of a patient's mental 1057
illness to the service provider for involuntary outpatient 1058
services or the administrator of a treatment facility if the 1059
patient is ordered for involuntary inpatient placement , whether 1060
by civil or criminal court . The documentation must include any 1061
advance directives made by the patient, a psychiatric evaluation 1062
of the patient, and any evaluations of the patient performed by 1063
a psychiatric nurse, a clinical psychologist, a marriage and 1064
family therapist, a mental health counselor, or a clinical 1065
social worker. The administrator of a treatment facility may 1066
refuse admission to any patient directed to its facilities on an 1067
involuntary basis, whether by civil or criminal court order, who 1068
is not accompanied by adequate orders and documentation. 1069
(9) TREATMENT PLAN MODIFICATION. —After the order for 1070
involuntary outpatient services is issued, the service provider 1071
and the patient may modi fy the treatment plan. For any material 1072
modification of the treatment plan to which the patient or, if 1073
one is appointed, the patient's guardian advocate agrees, the 1074
service provider shall send notice of the modification to the 1075
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court. Any material modificat ions of the treatment plan which 1076
are contested by the patient or the patient's guardian advocate, 1077
if applicable, must be approved or disapproved by the court 1078
consistent with subsection (4). 1079
(10) NONCOMPLIANCE WITH INVOLUNTARY OUTPATIENT SERVICES. —1080
If, in the clinical judgment of a physician, a patient receiving 1081
involuntary outpatient services has failed or has refused to 1082
comply with the treatment plan ordered by the court, and, in the 1083
clinical judgment of the physician, efforts were made to solicit 1084
compliance, and the patient may meet the criteria for 1085
involuntary examination, the patient may be brought to a 1086
receiving facility pursuant to s. 394.463. If, after 1087
examination, the patient does not meet the criteria for 1088
involuntary inpatient placement under this section, the patient 1089
must be discharged from the facility. The involuntary outpatient 1090
services order shall remain in effect unless the service 1091
provider determines that the patient no longer meets the 1092
criteria for involuntary outpatient services or until th e order 1093
expires. The service provider must determine whether 1094
modifications should be made to the existing treatment plan and 1095
must attempt to continue to engage the patient in treatment. For 1096
any material modification of the treatment plan to which the 1097
patient or the patient's guardian advocate, if applicable, 1098
agrees, the service provider shall send notice of the 1099
modification to the court. Any material modifications of the 1100
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treatment plan which are contested by the patient or the 1101
patient's guardian advocate, i f applicable, must be approved or 1102
disapproved by the court consistent with subsection (4). 1103
(11)(7) PROCEDURE FOR CONTINUED INVOLUNTARY SERVICES 1104
INPATIENT PLACEMENT.— 1105
(a) A petition for continued involuntary services shall be 1106
filed if the patient contin ues to meets the criteria for 1107
involuntary services. 1108
(b)1. If a patient receiving involuntary outpatient 1109
services continues to meet the criteria for involuntary 1110
outpatient services, the service provider shall file in the 1111
court that issued the order for in voluntary outpatient services 1112
a petition for continued involuntary outpatient services. 1113
2. If the patient in involuntary inpatient placement 1114
(a) Hearings on petitions for continued involuntary 1115
inpatient placement of an individual placed at any treatmen t 1116
facility are administrative hearings and must be conducted in 1117
accordance with s. 120.57(1), except that any order entered by 1118
the administrative law judge is final and subject to judicial 1119
review in accordance with s. 120.68. Orders concerning patients 1120
committed after successfully pleading not guilty by reason of 1121
insanity are governed by s. 916.15. 1122
(b) If the patient continues to meet the criteria for 1123
involuntary inpatient placement and is being treated at a 1124
treatment facility, the administrator shall, before the 1125
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expiration of the period the treatment facility is authorized to 1126
retain the patient, file a petition reque sting authorization for 1127
continued involuntary inpatient placement. 1128
3. The court shall immediately schedule a hearing on the 1129
petition to be held within 15 days after the petition is filed. 1130
4. The existing involuntary services order shall remain in 1131
effect until disposition on the petition for continued 1132
involuntary services. 1133
(c) A certificate for continued involuntary services must 1134
be attached to the petition and shall include The request must 1135
be accompanied by a statement from the patient's physician, 1136
psychiatrist, psychiatric nurse, or clinical psychologist 1137
justifying the request, a brief description of the patient's 1138
treatment during the time he or she was receiving involuntary 1139
services involuntarily placed , and, if requesting involuntary 1140
outpatient services, an individualized plan of continued 1141
treatment. The individualized plan of continued treatment shall 1142
be developed in consultation with the patient or the patient's 1143
guardian advocate, if applicable. When the petition has been 1144
filed, the clerk of th e court shall provide copies of the 1145
certificate and the individualized plan of continued services to 1146
the department, the patient, the patient's guardian advocate, 1147
the state attorney, and the patient's private counsel or the 1148
public defender. 1149
(d) The court shall appoint counsel to represent the 1150
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person who is the subject of the petition for continued 1151
involuntary services in accordance with subsection (5), unless 1152
the person is otherwise represented by counsel or ineligible. 1153
(e) Hearings on petitions for con tinued involuntary 1154
outpatient services must be before the court that issued the 1155
order for involuntary outpatient services. However, the patient 1156
and the patient's attorney may agree to a period of continued 1157
outpatient services without a court hearing. 1158
(f) Hearings on petitions for continued involuntary 1159
inpatient placement must be held in the county or the facility, 1160
as appropriate, where the patient is located. 1161
(g) The court may appoint a magistrate to preside at the 1162
hearing. The procedures for obtaining an order pursuant to this 1163
paragraph must meet the requirements of subsection (7). 1164
(h) Notice of the hearing must be provided as set forth 1165
provided in s. 394.4599. 1166
(i) If a patient's attendance at the hearing is 1167
voluntarily waived, the administrative law judge must determine 1168
that the patient knowingly, intelligently, and voluntarily 1169
waived his or her right to be present waiver is knowing and 1170
voluntary before waiving the presence of the patient from all or 1171
a portion of the hearing. Alternatively, if at th e hearing the 1172
administrative law judge finds that attendance at the hearing is 1173
not consistent with the best interests of the patient, the 1174
administrative law judge may waive the presence of the patient 1175
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from all or any portion of the hearing, unless the pati ent, 1176
through counsel, objects to the waiver of presence. The 1177
testimony in the hearing must be under oath, and the proceedings 1178
must be recorded. 1179
(j) Hearings on petitions for continued involuntary 1180
inpatient placement of an individual placed at any treatme nt 1181
facility are administrative hearings and must be conducted in 1182
accordance with s. 120.57(1), except that any order entered by 1183
the judge is final and subject to judicial review in accordance 1184
with s. 120.68. Orders concerning patients committed after 1185
successfully pleading not guilty by reason of insanity are 1186
governed by s. 916.15. 1187
(c) Unless the patient is otherwise represented or is 1188
ineligible, he or she shall be represented at the hearing on the 1189
petition for continued involuntary inpatient placement by the 1190
public defender of the circuit in which the facility is located. 1191
(k)(d) If at a hearing it is shown that the patient 1192
continues to meet the criteria for involuntary services 1193
inpatient placement, the court administrative law judge shall 1194
issue an sign the order for continued involuntary services 1195
inpatient placement for up to 90 days. However, any order for 1196
involuntary inpatient placement or mental health services in a 1197
combination of involuntary services treatment facility may be 1198
for up to 6 months. The s ame procedure shall be repeated before 1199
the expiration of each additional period the patient is 1200
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retained. 1201
(l) If the patient has been ordered to undergo involuntary 1202
services and has previously been found incompetent to consent to 1203
treatment, the court shal l consider testimony and evidence 1204
regarding the patient's competence. If the patient's competency 1205
to consent to treatment is restored, the discharge of the 1206
guardian advocate shall be governed by s. 394.4598. If the 1207
patient has been ordered to undergo invol untary inpatient 1208
placement only and the patient's competency to consent to 1209
treatment is restored, the administrative law judge may issue a 1210
recommended order, to the court that found the patient 1211
incompetent to consent to treatment, that the patient's 1212
competence be restored and that any guardian advocate previously 1213
appointed be discharged. 1214
(m)(e) If continued involuntary inpatient placement is 1215
necessary for a patient in involuntary inpatient placement who 1216
was admitted while serving a criminal sentence, but his or her 1217
sentence is about to expire, or for a minor involuntarily 1218
placed, but who is about to reach the age of 18, the 1219
administrator shall petition the administrative law judge for an 1220
order authorizing continued involuntary inpatient placement. 1221
(n)(f) If the patient has been previously found 1222
incompetent to consent to treatment, the administrative law 1223
judge shall consider testimony and evidence regarding the 1224
patient's competence. If the administrative law judge finds 1225
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evidence that the patient is now com petent to consent to 1226
treatment, the administrative law judge may issue a recommended 1227
order to the court that found the patient incompetent to consent 1228
to treatment that the patient's competence be restored and that 1229
any guardian advocate previously appointed be discharged. 1230
(o)(g) If the patient has been ordered to undergo 1231
involuntary inpatient placement and has previously been found 1232
incompetent to consent to treatment, the court shall consider 1233
testimony and evidence regarding the patient's incompetence. If 1234
the patient's competency to consent to treatment is restored, 1235
the discharge of the guardian advocate shall be governed by s. 1236
394.4598. 1237
1238
The procedure required in this section subsection must be 1239
followed before the expiration of each additional period the 1240
patient is involuntarily receiving services. 1241
(12)(8) RETURN TO FACILITY.—If a patient has been ordered 1242
to undergo involuntary inpatient placement involuntarily held at 1243
a treatment facility under this part leaves the facility without 1244
the administrator's au thorization, the administrator may 1245
authorize a search for the patient and his or her return to the 1246
facility. The administrator may request the assistance of a law 1247
enforcement agency in this regard. 1248
(13) DISCHARGE.—The patient shall be discharged upon 1249
expiration of the court order or at any time that the patient no 1250
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longer meets the criteria for involuntary services, unless the 1251
patient has transferred to voluntary status. Upon discharge, the 1252
service provider or facility shall send a certificate of 1253
discharge to the court. 1254
Section 6. Subsections (5) and (6) of section 394.492, 1255
Florida Statutes, are amended to read: 1256
394.492 Definitions. —As used in ss. 394.490 -394.497, the 1257
term: 1258
(5) "Child or adolescent who has an emotional disturbance" 1259
means a person under 18 years of age who is diagnosed with a 1260
mental, emotional, or behavioral disorder of sufficient duration 1261
to meet one of the diagnostic categories specified in the most 1262
recent edition of the Diagnostic and Statistical Manual of the 1263
American Psychiatric Association, but who does not exhibit 1264
behaviors that substantially interfere with or limit his or her 1265
role or ability to function in the family, school, or community. 1266
The emotional disturbance must not be considered to be a 1267
temporary response to a stressfu l situation. The term does not 1268
include a child or adolescent who meets the criteria for 1269
involuntary placement under s. 394.467 s. 394.467(1). 1270
(6) "Child or adolescent who has a serious emotional 1271
disturbance or mental illness" means a person under 18 years of 1272
age who: 1273
(a) Is diagnosed as having a mental, emotional, or 1274
behavioral disorder that meets one of the diagnostic categories 1275
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specified in the most recent edition of the Diagnostic and 1276
Statistical Manual of Mental Disorders of the American 1277
Psychiatric Association; and 1278
(b) Exhibits behaviors that substantially interfere with 1279
or limit his or her role or ability to function in the family, 1280
school, or community, which behaviors are not considered to be a 1281
temporary response to a stressful situation. 1282
1283
The term includes a child or adolescent who meets the criteria 1284
for involuntary placement under s. 394.467 s. 394.467(1). 1285
Section 7. Paragraphs (a) and (c) of subsection (3) of 1286
section 394.495, Florida Statutes, are amended to read: 1287
394.495 Child and adolescent mental health system of care; 1288
programs and services. — 1289
(3) Assessments must be performed by: 1290
(a) A clinical psychologist, clinical social worker, 1291
physician, psychiatric nurse, or psychiatrist, as those terms 1292
are defined in s. 394.455 professional as defined in s. 1293
394.455(5), (7), (33), (36), or (37) ; 1294
(c) A person who is under the direct supervision of a 1295
clinical psychologist, clinical social worker, physician, 1296
psychiatric nurse, or psychiatrist, as those terms are defined 1297
in s. 394.455, qualified professional as defined in s. 1298
394.455(5), (7), (33), (36), or (37) or a professional licensed 1299
under chapter 491. 1300
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Section 8. Subsection (5) of section 394.496, Florida 1301
Statutes, is amended to read: 1302
394.496 Service planning. — 1303
(5) A clinical psychologist, clinical social worker, 1304
physician, psychiatric nurse, or psychiatrist, as those terms 1305
are defined in s. 394.455, professional as defined in s. 1306
394.455(5), (7), (33), (36), or (37) or a professional licensed 1307
under chapter 491 must be included amo ng those persons 1308
developing the services plan. 1309
Section 9. Subsection (6) of section 394.9085, Florida 1310
Statutes, is amended to read: 1311
394.9085 Behavioral provider liability. — 1312
(6) For purposes of this section, the terms 1313
"detoxification services," "addictions receiving facility," and 1314
"receiving facility" have the same meanings as those provided in 1315
ss. 397.311(26)(a)4. 397.311(26)(a)3., 397.311(26)(a)1., and 1316
394.455 394.455(40), respectively. 1317
Section 10. Paragraph (b) of subsection (1) of section 1318
409.972, Florida Statutes, is amended to read: 1319
409.972 Mandatory and voluntary enrollment. — 1320
(1) The following Medicaid -eligible persons are exempt 1321
from mandatory managed care enrollment required by s. 409.965, 1322
and may voluntarily choose to participate in the managed medical 1323
assistance program: 1324
(b) Medicaid recipients residing in residential commitment 1325
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facilities operated through the Department of Juvenile Justice 1326
or a treatment facility as defined in s. 394.455 s. 394.455(49). 1327
Section 11. Paragraph ( e) of subsection (4) of section 1328
464.012, Florida Statutes, is amended to read: 1329
464.012 Licensure of advanced practice registered nurses; 1330
fees; controlled substance prescribing. — 1331
(4) In addition to the general functions specified in 1332
subsection (3), an a dvanced practice registered nurse may 1333
perform the following acts within his or her specialty: 1334
(e) A psychiatric nurse, who meets the requirements in s. 1335
394.455 s. 394.455(36), within the framework of an established 1336
protocol with a psychiatrist, may presc ribe psychotropic 1337
controlled substances for the treatment of mental disorders. 1338
Section 12. Subsection (7) of section 744.2007, Florida 1339
Statutes, is amended to read: 1340
744.2007 Powers and duties. — 1341
(7) A public guardian may not commit a ward to a treat ment 1342
facility, as defined in s. 394.455 s. 394.455(49), without an 1343
involuntary placement proceeding as provided by law. 1344
Section 13. This act shall take effect July 1, 2024. 1345