02-000104RX Alberta Lash vs. Department Of Children And Family Services
 Status: Closed
DOAH Final Order on Friday, April 19, 2002.


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Summary: Rules 65E-5.2301 and 65E-5.170, Florida Administrative Code, are not invalid exercise of delegated legislative authority.

1STATE OF FLORIDA

4DIVISION OF ADMINISTRATIVE HEARINGS

8ALBERTA LASH, )

11)

12Petitioner, )

14)

15vs. ) Case No. 02 - 01 04RX

23)

24DEPARTMENT OF CHILDREN AND )

29FAMILY SERVICES, )

32)

33Respondent. )

35___________________________________)

36FINAL ORDER

38Pursuant to no tice, a final hearing was held in this case

50on February 2, 2002, in Tallahassee, Florida, before Florence

59Snyder Rivas, a duly - designated Administrative Law Judge of the

70Division of Administrative Hearings.

74APPEARANCES

75For Petitioner: Frederick A. G oldstein, Esquire

82Post Office Box 22463

86Fort Lauderdale, Florida 33335 - 2463

92For Respondent: John Raymaker, Esquire

97Department of Children and Family Services

10313 17 Winewood Boulevard

107Building 2, Room 204

111Tallahassee, Florida 32399

114STATEMENT OF THE ISSUE

118Whether Rules 65E - 5.2301(1) and (3) and 65E - 5.170, Florida

130Administrative Code, constitute an invalid exercise o f delegated

139legislative authority.

141PRELIMINARY STATEMENT

143On January 8, 2002, the Petitioner, Alberta Lash

151(Petitioner or Lash), filed a Petition Pursuant to Section

160120.56, F.S., Seeking the Invalidity of Rules 65E - 5.2301(1) and

171(3) and 65E - 5.170, Promul gated by the Department of Children and

184Families (the Petition).

187The relevant facts are undisputed and are set forth here to

198the extent necessary to the rendition of a Final Order. The

209facts agreed to by the parties are more fully detailed in a

221“Stipulat ion for Final Hearing” (Stipulation) dated January 31,

2302002. The documents attached to the Petition are true and

240correct copies, are admissible and admitted into evidence, and

249may be relied upon by either side in these proceedings.

259A one - volume transcript was filed on February 8, 2002. The

271parties sought and received an enlargement of time to March 8,

2822002, for the filing of proposed orders, which were timely filed

293and which have been carefully considered in the preparation of

303this Final Order.

306FINDINGS OF FACT

3091. All procedural requirements for promulgation of Rules

31765E - 5.2301(1) and (3) and 65E - 5.170, Florida Administrative Code

329(the challenged Rules) were properly fulfilled.

3352. Lash has standing to litigate the validity of the

345challenged Rules.

3473. O n September 20, 2001, Lash was admitted to the Crisis

359Screening and Stabilization Unit (Unit) located in Fort

367Lauderdale, Florida. The Unit is authorized to receive patients

376pursuant to that portion of Chapter 394.453 of the Florida

386Mental Health Act, mor e popularly known as the Baker Act.

3974. Following Lash’s admission to the Unit, a document

406entitled Certificate of Patient’s Incapacity to Consent and

414Notification of Health Care Surrogate/Proxy (Certificate) was

421executed by two physicians (Two Physicians) . Pursuant to the

431Certificate, the Two Physicians declared Lash incompetent to

439consent to treatment and appointed a Third Party (Third Party)

449to make medical decisions on her behalf, including authorizing

458treatment objected to by Lash.

4635. In so doing, th e parties are of the opinion that the

476Two Physicians were acting pursuant to the challenged Rules.

485CONCLUSIONS OF LAW

4886. The Division of Administrative Hearings has

495jurisdiction over this proceeding and the parties thereto

503pursuant to Section 120.56, Flor ida Statutes.

5107. The challenged Rules are presumptively valid; it is

519therefore Lash's burden to demonstrate the invalidity of the

528challenged Rules. Section 120.56(3) Florida Statutes; St. Johns

536River Water Management District v. Consolidated - Tomoka Land Co. ,

546717 So. 2d. 72 (Fla. 1st DCA 1998), rev . den ., 727 So. 2d 904

562(Fla. 1999).

5648. For the reasons set forth below, the challenged Rules,

574standing alone, cannot be reasonably read to authorize the

583appointment of a Third Party to give consent to treatmen t to

595which a patient objects under the facts and circumstances of

605this case; thus Lash has not shown the challenged Rule(s) to be

617an invalid exercise of delegated authority.

6239. In order to adopt any administrative rule, the agency

633engaged in the rulemak ing must be acting in accordance with a

645grant of specific legislative authority. Southwest Fla. Water

653Mgmt. Dist. v. Save the Manatee Club, Inc. , 773 So. 2d (Fla. 1st

666DCA 2000); Florida Board of Medicine v. Florida Academy of

676Cosmetic Surgery, Inc. , 808 S o. 2d. 243 (Fla. 1st DCA 2002).

68810. The challenged Rules provide, in full, as follows:

697Rule 65E - 5.2301 Health Care Surrogate or

705Proxy.

706(1) During the interim period between the

713time a patient is determined to be

720incompetent to consent to treatment by one

727or more physicians, pursuant to s. 765.204,

734F.S., and the time a guardian advocate is

742appointed by a court to provide express and

750informed consent to the patient's treatment,

756a health care surrogate designated by the

763patient, pursuant to chapter 765 , part II,

770F.S., may provide such consent to treatment.

777(2) In the absence of an advance

784directive, a health care proxy, pursuant to

791chapter 765, part IV, F.S., may also provide

799interim consent to treatment.

803(3) Upon the documented determination

808that a patient is incompetent to make health

816care decisions for himself or herself by one

824or more physicians, pursuant to s. 765.204,

831F.S., the facility shall notify the

837surrogate or proxy in writing that the

844conditions under which he or she can

851exercise his o r her authority under the law

860have occurred. Use of recommended form CF -

868MH 3122, Jan. 98, "Certification of

874Patient's Incompetence to Consent to

879Treatment and Notification of Health Care

885Surrogate/Proxy," which is incorporated by

890reference as if fully set out here and may

899be obtained from the district mental health

906program office, will be considered by the

913department to be sufficient for this

919purpose.

920(4) A petition for adjudication of

926incompetence to consent to treatment and

932appointment of a guardian a dvocate shall be

940filed with the court within two court

947working days of the determination of the

954patient's incompetence to consent to

959treatment by one or more physicians,

965pursuant to s. 765.204, F.S. Use of

972recommended form CF - MH 3106, "Petition for

980Adjudi cation of Incompetence to Consent to

987Treatment and Appointment of a Guardian

993Advocate," as referenced in 65E -

9995.170(1)(d)2., will be considered by the

1005department to be sufficient for this

1011purpose.

1012(5) The facility shall immediately

1017provide to the health care surrogate or

1024proxy the same information required by

1030statute to be provided to the guardian

1037advocate. In order to protect the safety of

1045the patient, the facility shall make

1051available to the health care surrogate or

1058proxy the training required of guard ian

1065advocates and ensure that the surrogate or

1072proxy communicate with the patient and

1078patient's physician, as defined in s.

1084394.455(21), F.S., prior to giving express

1090and informed consent to treatment.

1095Specific Authority 394.457(5) FS.

1099Law Implemented 394. 4598, 765 FS.

1105History -- New 11 - 29 - 98, Amended 1 - 16 - 2001.

1119* * *

112265E - 5.170 Express and Informed Consent.

1129(1) Establishment of Consent.

1133(a) Receiving Facilities. As soon as

1139possible, but in no event longer than 24

1147hours from entering a designated re ceiving

1154facility on a voluntary or involuntary

1160basis, each patient shall be examined by the

1168admitting physician, as defined in s.

1174394.455(21), F.S., to determine the

1179patient's ability to provide express and

1185informed consent to admission and treatment.

1191The examination of a minor for this purpose

1199may be limited to the documentation of the

1207minor's age. The examination of a person

1214alleged to be incapacitated for this purpose

1221may be limited to the documentation of

1228letters of guardianship. Documentation of

1233this determination shall be placed in the

1240patient's clinical record. The facility

1245shall determine whether a patient has been

1252adjudicated as incapacitated and whether a

1258guardian has been appointed by the court.

1265If a guardian has been appointed by the

1273court, t he limits of the authority of the

1282guardian shall be determined prior to

1288allowing the guardian to authorize

1293treatment. A copy of any court order

1300delineating a guardian's authority to

1305consent to mental health or medical

1311treatment shall be obtained by the fa cility

1319and included in the patient's clinical

1325record prior to allowing the guardian to

1332give express and informed consent to

1338treatment for the patient.

1342(b) Treatment Facilities. Upon entering

1347a designated treatment facility on a

1353voluntary or involuntary basis, each patient

1359shall be examined by the admitting

1365physician, as defined in s. 394.455(21),

1371F.S., to determine the patient's ability to

1378provide express and informed consent to

1384admission and treatment, which shall be

1390documented in the patient's clinica l record.

1397The examination of a person alleged to be

1405incapacitated or incompetent to consent to

1411treatment, for this purpose, may be limited

1418to documenting the letters of guardianship

1424or order of the court. If a patient has

1433been adjudicated as incapacitate d and a

1440guardian appointed by the court or if a

1448patient has been found to be incompetent to

1456consent to treatment and a guardian advocate

1463has been appointed by the court, the limits

1471of authority of the guardian or guardian

1478advocate shall be determined prior to

1484allowing the guardian or guardian advocate

1490to authorize treatment for the patient. A

1497copy of any court order delineating a

1504guardian's authority to consent to mental

1510health or medical treatment shall be

1516obtained by the facility and included in the

1524pati ent's clinical record prior to allowing

1531the guardian to give express and informed

1538consent to treatment for the patient.

1544(c) If the admission is voluntary, the

1551patient's competence to provide express and

1557informed consent for admission shall be

1563documented by the admitting physician, as

1569defined in s. 394.455(21), F.S. Use of

1576recommended form CF - MH 3104, Jan. 98,

"1584Certification of Patient's Competence to

1589Provide Express and Informed Consent," which

1595is incorporated by reference as if fully set

1603out here and m ay be obtained from the

1612district mental health program office, will

1618be considered by the department to be

1625sufficient. The completed form or other

1631documentation shall be retained in the

1637patient's clinical record. Facility staff

1642monitoring the patient's co ndition shall

1648document any observations which suggest that

1654a patient may no longer be competent to

1662provide express and informed consent to his

1669or her treatment. In such circumstances,

1675staff shall notify the physician, as defined

1682in s. 394.455(21), F.S., a nd document in the

1691patient's clinical record that the

1696physician, as defined in s. 394.455(21),

1702F.S., was notified of this apparent change

1709in clinical condition.

1712(d) In the event a change in a voluntary

1721patient's clinical status affects the

1726patient's com petence to provide express and

1733informed consent to treatment, the change

1739shall be immediately documented in the

1745patient's clinical record. A person's

1750refusal to consent to treatment is not, in

1758itself, an indication of incompetence to

1764consent to treatment.

17671. If the patient is determined to be

1775competent to consent to treatment and meets

1782the criteria for involuntary placement, the

1788facility administrator shall file with the

1794court a petition for involuntary placement.

1800Use of recommended form CF - MH 3032, Ja n. 98,

"1811Petition for Involuntary Placement," which

1816is incorporated by reference as if fully set

1824out here and may be obtained from the

1832district mental health program office, will

1838be considered by the department to be

1845sufficient.

18462. If the patient is inco mpetent to

1854consent to treatment, and meets the criteria

1861for involuntary placement, the facility

1866administrator shall expeditiously file with

1871the court both a petition for the

1878adjudication of incompetence to consent to

1884treatment and appointment of a guardian

1890advocate, and a petition for involuntary

1896placement. Upon determination that a

1901patient is incompetent to consent to

1907treatment the facility shall expeditiously

1912pursue the appointment of a duly authorized

1919substitute decision - maker that can make

1926legally requ ired decisions concerning

1931treatment options or refusal of treatments

1937for the patient. Use of recommended forms

1944CF - MH 3106, Jan. 98, "Petition for

1952Adjudication of Incompetence to Consent to

1958Treatment and Appointment of a Guardian

1964Advocate," which is incorp orated by

1970reference as if fully set out here and may

1979be obtained from the district mental health

1986program office, and CF - MH 3032, "Petition

1994for Involuntary Placement," as referenced in

200065E - 5.170(1)(d)1., will be considered by the

2008department to be sufficient .

2013(e) Competence to provide express and

2019informed consent shall be established and

2025documented in the patient's clinical record

2031prior to the approval of a patient's

2038transfer from involuntary to voluntary

2043status or prior to permitting a patient to

2051consent to his or her own treatment if that

2060patient had been previously determined to be

2067incompetent to consent to treatment. Use of

2074recommended form CF - MH 3104, "Certification

2081of Patient's Competence to Provide Express

2087and Informed Consent," as referenced in 65E -

20955.170(1)(c), properly completed by a

2100physician, as defined in s. 394.455(21),

2106F.S., will be considered by the department

2113to be sufficient.

2116(f) Any guardian advocate appointed by a

2123court to provide express and informed

2129consent to treatment for the patie nt shall

2137be discharged and a notice of such guardian

2145advocate discharge provided to the court

2151upon the establishment and documentation

2156that the patient is competent to provide

2163express and informed consent.

2167(g) If a patient entering a designated

2174receivin g or treatment facility has been

2181adjudicated incapacitated under chapter 744,

2186F.S., as described in s. 394.455(14), F.S.,

2193express and informed consent to treatment

2199shall be sought from the patient's guardian.

2206(h) If a patient entering a designated

2213recei ving or treatment facility has been

2220determined by the attending physician and

2226another physician, as defined in s.

2232394.455(21), F.S., to be incompetent to

2238consent to treatment as defined in s.

2245394.455(15), F.S., express and informed

2250consent to treatment sha ll be expeditiously

2257sought by the facility from the patient's

2264guardian advocate or health care surrogate

2270or proxy.

2272(i) A copy of the letter of guardianship,

2280court order, or advance directive shall be

2287reviewed by facility staff to ensure that

2294the substit ute decision - maker has the

2302authority to provide consent to the

2308recommended treatment on behalf of the

2314patient. If the facility relies upon the

2321expression of express and informed consent

2327for patient treatment from a substitute

2333decision - maker, a copy of thi s documentation

2342shall be placed in the patient's clinical

2349record and shall serve as documentation of

2356the substitute decision - maker's authority to

2363give such consent. With respect to a health

2371care proxy, where no advance directive has

2378been prepared by the p atient, facility staff

2386shall document in the patient's clinical

2392record that the substituted decision - maker

2399was selected in accordance with the list of

2407persons and using the priority set out in s.

2416765.401, F.S. When a health care surrogate

2423or proxy is used , the facility shall

2430immediately petition for the appointment of

2436a guardian advocate.

2439(2) Authorization for Treatment.

2443(a) Express and informed consent,

2448including the right to ask questions about

2455the proposed treatment, to receive complete

2461and accura te answers to those questions, and

2469to negotiate treatment options, shall be

2475obtained from a patient who is competent to

2483consent to treatment. If the patient is

2490incompetent to consent to treatment, such

2496express and informed consent shall be

2502obtained from t he duly authorized substitute

2509decision - maker for the patient before any

2517treatment is rendered, except where

2522emergency treatment is ordered by a

2528physician, as defined in s. 394.455(21),

2534F.S., for the safety of the patient or

2542others.

2543(b) A copy of informa tion disclosed while

2551attempting to obtain express and informed

2557consent shall be given to the patient and to

2566any substitute decision - maker authorized to

2573act on behalf of the patient.

2579(c) When presented with an event or an

2587alternative which requires expre ss and

2593informed consent, the competent patient or,

2599if the patient is incompetent to consent to

2607treatment, the duly authorized substitute

2612decision - maker, shall provide consent to

2619treatment, refuse consent to treatment,

2624negotiate treatment alternatives, or r evoke

2630consent to treatment. Use of recommended

2636forms CF - MH 3042a, Jan. 98, "General

2644Authorization for Treatment Except

2648Psychotropic Medications," which is

2652incorporated by reference as if fully set

2659out here and may be obtained from the

2667district mental heal th program office, and

2674CF - MH 3042b, Jan. 98, "Specific

2681Authorization for Psychotropic Medications,"

2685which is incorporated by reference as if

2692fully set out here and may be obtained from

2701the district mental health program office,

2707will be considered by the de partment to be

2716sufficient as documentation of express and

2722informed consent and any decisions made

2728pursuant to that consent. If used,

2734recommended form CF - MH 3042a, "General

2741Authorization for Treatment Except

2745Psychotropic Medications," as referenced in

275065E - 5.170(2)(c), shall be completed at the

2758time of admission to permit routine medical

2765care, psychiatric assessment, and other

2770assessment and treatment except psychotropic

2775medications. The more specific recommended

2780form CF - MH 3042b, "Specific Authorization

2787fo r Psychotropic Medications," as referenced

2793in 65E - 5.170(2)(c), or its equivalent, shall

2801be completed prior to the administration of

2808any psychotropic medications, except under

2813an emergency treatment order. The completed

2819forms, or equivalent documentation, shall be

2825retained in the patient's clinical record.

2831(d) No facility shall initiate any mental

2838health treatment, including psychotropic

2842medication, until express and informed

2847consent for psychiatric treatment is

2852obtained from a person legally qualified t o

2860give it, except in cases where emergency

2867treatment is ordered by a physician, as

2874defined in s. 394.455(21), F.S., to preserve

2881the immediate safety of the patient or

2888others.

2889(3) Receiving and treatment facilities

2894shall request copies of any advance

2900dir ectives completed by persons admitted to

2907the facilities, from the patient or the

2914patient's family or representative.

2918(4) In addition to any other

2924requirements, at least the following must be

2931given to the patient before express and

2938informed consent will be valid:

2943(a) Identification of the proposed

2948medication, together with a plain language

2954explanation of the proposed dosage range,

2960the frequency and method of administration,

2966the recognized short - term and long - term side

2976effects, any contraindications whi ch may

2982exist, clinically significant interactive

2986effects with other medications, and similar

2992information on alternative medications which

2997may have less severe or serious side

3004effects.

3005(b) A plain language explanation of all

3012other treatments or treatment alternatives

3017recommended for the patient.

3021(5) If a change in medication is

3028recommended which is not included in the

3035previously signed CF - MH 3042b, "Specific

3042Authorization for Psychotropic Medications"

3046form, as referenced in 65E - 5.170(2)(c),

3053after an ex planation and disclosure of the

3061altered treatment plan is provided by the

3068physician, as defined in s. 394.455(21),

3074F.S., express and informed consent must be

3081obtained from the person authorized to

3087provide consent and be documented in the

3094patient's clinical record prior to the

3100administration of the treatment or

3105medication.

3106(6) The facility staff shall explain to a

3114guardian, guardian advocate, or health care

3120surrogate or proxy, the duty of the

3127substitute decision - maker to provide

3133information to the facilit y on how the

3141substitute decision - maker may be reached at

3149any time during the patient's

3154hospitalization to provide express and

3159informed consent for clinically significant

3164changes of treatment.

3167(7) To assure the safety and rights of

3175the patient, electroco nvulsive treatment may

3181be recommended to the patient or the

3188patient's substitute decision - maker by the

3195attending physician, as defined in s.

3201394.455(21), F.S., if concurrently

3205recommended by at least one other physician,

3212as defined in s. 394.455(21), F.S., not

3219directly involved with the patient's care

3225who has reviewed the patient's clinical

3231record. Such recommendation shall be

3236documented in the patient's clinical record

3242and shall be signed by both physicians, as

3250defined in s. 394.455(21), F.S. When

3256comple ted, recommended form CF - MH 3057,

3264Jan. 98, "Authorization for

3268Electroconvulsive Treatment," which is

3272incorporated by reference as if fully set

3279out here and may be obtained from the

3287district mental health program office, will

3293be considered by the department to be

3300sufficient. If used, this form shall also

3307be signed by the patient, if competent, or

3315by the guardian advocate, if previous court

3322approval has been given, or by the guardian

3330where the patient has been found by the

3338court to be incapacitated, or by th e health

3347care surrogate if the patient had expressly

3354delegated such authority to the surrogate in

3361the advance directive. Express and informed

3367consent from the patient or his or her

3375substitute decision - maker, as required by s.

3383394.459(3), F.S., including a n opportunity

3389to ask questions and receive answers about

3396the procedure, shall be noted on or attached

3404to recommended form CF - MH 3057,

"3411Authorization for Electroconvulsive

3414Treatment," as referenced in 65E - 5.170(7),

3421or its equivalent, as documentation of the

3428required disclosures and of the consent.

3434Each signed authorization form is permission

3440for the patient to receive a series of up

3449to, but not more than, a stated number of

3458electroconvulsive treatments. Additional

3461electroconvulsive treatments require

3464addit ional written authorization. The

3469signed authorization form shall be retained

3475in the patient's clinical record and shall

3482comply with the provisions of s. 458.325,

3489F.S.

3490Specific Authority 394.457(5) FS.

3494Law Implemented 394.455(5), 394.459(3) FS.

3499History -- Ne w 11 - 29 - 98.

350811. Lash has alleged that the challenged Rules are not

3518supported by the specific legislative authority cited by the

3527Department. Section 120.52(8)(b), Florida Statutes. In

3533particular, Lash has argued that the legislative authority

3541relied upo n by the Department does not authorize the appointment

3552by the Two Physicians of a Third Party to make medical decisions

3564on behalf of an individual such as Lash who was involuntarily

3575committed to a Baker Act facility, in this instance, the Unit.

358612. The sp ecific legislative authority cited for both of

3596the challenged Rules, Section 394.457(5), Florida Statutes,

3603states:

3604(5) Rules. —

3607(a) The department shall adopt rules

3613establishing forms and procedures relating

3618to the rights and privileges of patients

3625seek ing mental health treatment from

3631facilities under this part.

3635(b) The department shall adopt rules

3641necessary for the implementation and

3646administration of the provisions of this

3652part, and a program subject to the

3659provisions of this part shall not be

3666permi tted to operate unless rules designed

3673to ensure the protection of the health

3680safety, and welfare of the patients treated

3687through such program have been adopted.

369313. Thus, this section provides the Department with

3701general authority to adopt rules necessar y to carry out the

3712Baker Act program.

371514. The Department also relies generally upon Chapter 765,

3724Florida Statutes, Parts I - IV and 765.204(2), Florida Statutes,

3734in particular, as one of the laws implemented in Rule 65E -

37465.2301, Florida Administrative Code.

375015. Chapter 765, Florida Statutes, is titled “Health Care

3759Advance Directives.” The statute’s extensive statement of

3766legislative findings and intent, and the statute read as a

3776whole, demonstrate that this law is exclusively concerned with

3785the fundamental right of self - determination a civilized society

3795affords every competent adult in circumstances when s/he is

3804faced with the complex health care decisions which often

3813accompany an individual’s final illness.

381816. Chapter 765, Florida Statutes, is a legislati ve

3827response to the complex medical, moral, and ethical choices

3836which arise in our technologically advanced society when old

3845age, serious illness, or sudden injury impose cruel burdens upon

3855individuals and their loved ones.

386017. Specifically, the portion of Chapter 765, Florida

3868Statutes, relied upon by the Department, protects the

3876“fundamental right of self - determination regarding decisions

3884pertaining to [the rights of competent adults to make informed

3894decisions regarding] his or her own health, including th e right

3905to choose or refuse medical treatment. . . .” Section

3915765.102(1), Florida Statutes (2001).

391918. The balance of this Section occupies nearly a full

3929page of legislative findings and intent. Read as a whole, it

3940plainly does not address the circums tances under which an

3950incompetent individual may be involuntarily treated.

395619. Section 765.204(2), Florida Statutes, which was

3963heavily debated by the parties, provides:

3969(2) If a principal's capacity to make

3976health care decisions for herself or himself

3983or provide informed consent is in question,

3990the attending physician shall evaluate the

3996principal's capacity and, if the physician

4002concludes that the principal lacks capacity,

4008enter that evaluation in the principal's

4014medical record. If the attending physic ian

4021has a question as to whether the principal

4029lacks capacity, another physician shall also

4035evaluate the principal's capacity, and if

4041the second physician agrees that the

4047principal lacks the capacity to make health

4054care decisions or provide informed consen t,

4061the health care facility shall enter both

4068physician's evaluations in the principal's

4073medical record. If the principal has

4079designated a health care surrogate or has

4086delegated authority to make health care

4092decisions to an attorney in fact under a

4100durable power of attorney, the facility

4106shall notify such surrogate or attorney in

4113fact in writing that her or his authority

4121under the instrument has commenced, as

4127provided in chapter 709 or s. 765.203.

413420. The undersigned rejects the parties' view that either

4143or both of the challenged Rules confer expansive powers to

4153authorize involuntary treatment. Instead, the challenged Rules,

4160reasonably read and appropriately applied, merely restate the

4168legislative mandate that under the Health Care Advance

4176Directives law, in the interim period of time between a

4186determination of incompetence to consent to treatment and the

4195time a court - appointed guardian advocate is in place to provide

4207express and informed consent to treatment, consent may be

4216provided by a health care surro gate who has been previously

4227designated by the patient pursuant to the provisions of

4236Chapter 765, Part II, Florida Statutes, if such an individual

4246exists.

424721. In other words, Lash and others similarly situated

4256have a right to have their choice of a Chapte r 765, Florida

4269Statutes, health care surrogate honored in a Baker Act facility

4279(if, in fact, they have made such a choice) during the window of

4292time between when the individual is declared incompetent and

4301such time as a guardian advocate is appointed by a court of

4313competent jurisdiction to provide express and informed consent

4321to such treatment. The challenged Rules, neither singly nor in

4331combination, create, modify, or restrict the statutory rights of

4340any individual and Lash has failed to carry her burden to show

4352that the challenged Rules, as properly interpreted and properly

4361applied, are not supported by the specific legislative authority

4370relied upon by the Department.

437522. The parties have agreed that Lash and others have been

4386or may be in the future invo luntarily medicated by individuals

4397who believe they are acting under the authority of the

4407challenged Rules. As noted above, these Rules, given their

4416plain meaning, do not authorize the Two Physicians to appoint a

4427Third Party to give consent to medical tre atment objected to by

4439the patient.

444123. If the challenged Rules are being applied in a manner

4452inconsistent with their plain meaning, this is not a matter

4462which may be properly addressed by an administrative law judge.

4472It is beyond the authority of this fo rum to address an incorrect

4485agency interpretation of a rule which is valid on its face.

449624. The Department expansively argued that Chapter 765

4504and Chapter 394, taken together, “confer upon the Department

4513broad, unqualified authority to adopt rules e stablishing forms

4522and procedures relating to the rights and privileges of patients

4532seeking mental health treatment from facilities under the Baker

4541Act that ensure the protection of the health safety." This

4551argument goes far beyond the issues presented in this case.

456125. As the Department more narrowly stipulated at the

4570final hearing, there is one undeniable relationship between

4578Chapter 765 and Chapter 394, Florida Statutes. It is this: if

4589an individual such as Lash is in confinement in a Baker Act

4601facility such as the Unit, any and all advance directives which

4612comply with the requirements of Chapter 765, Florida Statutes,

4621must be honored by the Baker Act facility. If the Baker Act

4633facility is unwilling to honor the person's advance directives,

4642if any there be, the facility is required to transfer the

4653patient to a facility that will honor h/er advance directives.

4663Section 765.1105(1), Florida Statutes.

466726. As a matter of law and logic, this is the only

4679relationship between the two statutes relied u pon by the

4689Department in support of the challenged Rules, and it is

4699sufficient to sustain the validity of the challenged Rules.

470827. Other legal issues relative to the challenged Rules

4717were debated by the parties. For example, Lash argued that the

4728challen ged Rules unconstitutionally infringe upon her rights

4736under Article V Section 20(c)(3) of the Florida Constitution.

474528. In response, the Department argued that the

4753undersigned can decide this case in Lash’s favor if and only if

"4765this [Administrative Law ] Court . . . find[s] that Section

4776765.101 to 765.404, Florida Statutes, et seq ., are

4785unconstitutional."

478629. In support of this argument, the Department correctly

4795asserts that the constitutionality of a statute is not within

4805the jurisdiction of this foru m. Key Haven Associated

4814Enterprises, Inc. v. Board of Trustees of the Internal

4823Improvement Trust Fund , 427 So. 2d 153 (Fla. 1982).

483230. However, the record does not support the legal

4841inference that the Department seeks to draw from that black

4851letter law, i.e. that Lash’s petition must be dismissed because

4861a decision in her favor cannot be rendered absent a finding that

4873portions of Chapter 765 of the Florida Statutes are

4882unconstitutional.

488331. The undersigned must and does decline Lash’s

4891invitation to consi der and render conclusions of law regarding

4901the constitutionality of the challenged Rules. It is neither

4910appropriate to do so, nor necessary to the disposition of this

4921case.

4922CONCLUSION

4923Based upon the foregoing, it is ORDERED that the challenged

4933Rules do n ot constitute an invalid exercise of delegated

4943legislative authority.

4945DONE AND ORDERED this 19th day of April, 2002, in

4955Tallahassee, Leon County, Florida.

4959___________________________________

4960FLORENCE SNYDER RIVAS

4963Administrative Law Judge

4966Division of Admini strative Hearings

4971The DeSoto Building

49741230 Apalachee Parkway

4977Tallahassee, Florida 32399 - 3060

4982(850) 488 - 9675 SUNCOM 278 - 9675

4990Fax Filing (850) 921 - 6847

4996www.doah.state.fl.us

4997Filed with the Clerk of the

5003Division of Administrative Hearings

5007this 19th day o f April, 2002.

5014COPIES FURNISHED:

5016Frederick A. Goldstein, Esquire

5020Post Office Box 22463

5024Fort Lauderdale, Florida 33335 - 2463

5030John Raymaker, Esquire

5033Department of Children and

5037Family Services

50391317 Winewood Boulevard

5042Building 2, Room 204

5046Tallahassee, Fl orida 32399 - 0700

5052Peggy Sanford, Agency Clerk

5056Department of Children and

5060Family Services

50621317 Winewood Boulevard

5065Building 2, Room 204B

5069Tallahassee, Florida 32399 - 0700

5074Josefina Tamayo, General Counsel

5078Department of Children and

5082Family Services

50841317 W inewood Boulevard

5088Building 2, Room 204

5092Tallahassee, Florida 32399 - 0700

5097Carroll Webb

5099Executive Director and General Counsel

5104Joint Administrative Procedures Committee

5108Holland Building, Room 120

5112Tallahassee, Florida 32399 - 1300

5117NOTICE OF RIGHT TO JUDI CIAL REVIEW

5124A party who is adversely affected by this Final Order is

5135entitled to judicial review pursuant to Section 120.68, Florida

5144Statutes. Review proceedings are governed by the Florida Rules

5153of Appellate Procedure. Such proceedings are commenced by

5161filing the original notice of appeal with the Clerk of the

5172Division of Administrative Hearings and a copy, accompanied by

5181filing fees prescribed by law, with the District Court of

5191Appeal, First District, or with the District Court of Appeal in

5202the Appellat e District where the party resides. The notice of

5213appeal must be filed within 30 days of rendition of the order to

5226be reviewed.

Select the PDF icon to view the document.
PDF
Date
Proceedings
PDF:
Date: 04/23/2003
Proceedings: Opinion filed.
PDF:
Date: 04/23/2003
Proceedings: Mandate filed.
PDF:
Date: 04/21/2003
Proceedings: Mandate
PDF:
Date: 04/17/2003
Proceedings: Opinion
Date: 04/17/2003
Proceedings: Opinion
PDF:
Date: 08/26/2002
Proceedings: Index, Record, Certificate of Record sent out.
PDF:
Date: 07/02/2002
Proceedings: Index sent out.
PDF:
Date: 05/15/2002
Proceedings: Certified Notice of Administrative Appeal sent out.
PDF:
Date: 04/19/2002
Proceedings: DOAH Final Order
PDF:
Date: 04/19/2002
Proceedings: Final Order issued (hearing held February 2, 2002). CASE CLOSED.
PDF:
Date: 03/08/2002
Proceedings: Agency`s Proposed Hearing Officer`s Recommended Order Affirming Agency Action filed.
PDF:
Date: 03/07/2002
Proceedings: (Proposed) Final Order filed by Petitioner.
Date: 02/08/2002
Proceedings: Transcript filed.
Date: 02/01/2002
Proceedings: CASE STATUS: Hearing Held; see case file for applicable time frames.
PDF:
Date: 01/31/2002
Proceedings: Notice of Appearance (filed by Respondent).
PDF:
Date: 01/31/2002
Proceedings: Notice of Change of Telephone Number for the Hearing Scheduled for February 1, 2002 @ 9:00 a.m. (filed by Petitioner via facsimile).
PDF:
Date: 01/31/2002
Proceedings: (Joint) Stipualtion for Final Hearing (filed via facsimile).
PDF:
Date: 01/31/2002
Proceedings: Petitioner`s Motion and Memorandum in Opposition to Respondent`s Motion to Dismiss (filed via facsimile).
PDF:
Date: 01/29/2002
Proceedings: Notice of Use of Notary for Witnesses at the Hearing Scheduled for February 1, 2002 @ 9:00 a.m. via Telephone and Notice of the Telephone Number filed by Petitioner.
PDF:
Date: 01/25/2002
Proceedings: Notice of Use of Notary for Witnesses at the Hearing Scheduled for February 1, 2002 @ 9:00 a.m. via Telephone and Notice of the Telephone Number (filed by Petitioner via facsimile).
PDF:
Date: 01/24/2002
Proceedings: Motion to Dismiss filed by Respondent.
PDF:
Date: 01/17/2002
Proceedings: Motion to Permit Appearances either by Teleconference or by Telephone or in the Alternative to Change the Location of the Final Hearing to South Florida State Hospital in Broward County, Florida (filed by Petitioner via facsimile).
PDF:
Date: 01/14/2002
Proceedings: Notice of Hearing issued (hearing set for February 1, 2002; 9:00 a.m.; Tallahassee, FL).
PDF:
Date: 01/10/2002
Proceedings: Order of Assignment issued.
PDF:
Date: 01/10/2002
Proceedings: Letter to Liz Cloud from A. Cole with copy to Carroll Webb and the Agency General Counsel sent out.
PDF:
Date: 01/09/2002
Proceedings: Petition Pursuant to Section 120.56, F.S. Seeking the Invalidity of Rules 65E-5.230(1)(3) and 65E-5.170 Promulgated by the Department of Children and Families filed.
PDF:
Date: 01/09/2002
Proceedings: Agency referral filed.

Case Information

Judge:
FLORENCE SNYDER RIVAS
Date Filed:
01/09/2002
Date Assignment:
01/29/2002
Last Docket Entry:
04/23/2003
Location:
West Palm Beach, Florida
District:
Southern
Agency:
Department of Children and Families
Suffix:
RX
 

Counsels

Related Florida Statute(s) (15):