02-000104RX
Alberta Lash vs.
Department Of Children And Family Services
Status: Closed
DOAH Final Order on Friday, April 19, 2002.
DOAH Final Order on Friday, April 19, 2002.
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
221Stipulat 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 Lashs admission to the Unit, a document
406entitled Certificate of Patients 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 statutes 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 individuals 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
3876fundamental 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 Lashs 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 Lashs 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 Lashs
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.
- Date
- Proceedings
- Date: 04/17/2003
- Proceedings: Opinion
- PDF:
- Date: 03/08/2002
- Proceedings: Agency`s Proposed Hearing Officer`s Recommended Order Affirming Agency Action filed.
- 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 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: 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: 01/17/2002
- 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: Letter to Liz Cloud from A. Cole with copy to Carroll Webb and the Agency General Counsel sent out.
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
-
Frederick Allan Goldstein, Esquire
Address of Record -
John Anthony Raymaker, Esquire
Address of Record