The purpose and effect of the proposed rulemaking is to revise the Department’s policies governing provision of mental health services to inmates in accordance with statutory changes outlined in Chapter 2008-250, Laws of Florida.

DEPARTMENT OF CORRECTIONS

Rule No.: RULE TITLE
33-404.101: Mental Health Services Program - Purpose and Scope
33-404.102: Provision of Mental Health Services
33-404.103: Mental Health Services - Definitions
33-404.104: Mental Health Services - Classification System
33-404.105: Consent to Mental Health Evaluation and Treatment
33-404.106: Admission to Isolation Management, Transitional Care, or Crisis Stabilization
33-404.201: Operation, Administration, and Designation of Mental Health Treatment Facilities
33-404.202: Mental Health Treatment Facilities - Definitions
33-404.203: Mental Health Treatment Facilities - Care of Inmates
33-404.204: Mental Health Treatment Facilities - Use of Force
33-404.205: Mental Health Treatment Facilities - Inmate Discipline
33-404.206: Mental Health Treatment Facilities - Administrative Confinement
33-404.207: Mental Health Treatment Facilities - Restrictions of Inmate Privileges
33-404.208: Mental Health Treatment Facilities - Admissible Reading Material
33-404.209: Mental Health Treatment Facilities - Forms
33-404.2095: Placement in Mental Health Treatment Facilities
33-404.2096: Emergency Placement in Mental Health Treatment Facilities
33-404.2097: Discharge From Mental Health Treatment Facilities
33-404.2098: Continued Placement in Mental Health Treatment Facilities
33-404.210: Mental Health Treatment Facilities - Consent to Psychiatric Treatment
PURPOSE AND EFFECT: The purpose and effect of the proposed rulemaking is to revise the Department’s policies governing provision of mental health services to inmates in accordance with statutory changes outlined in Chapter 2008-250, Laws of Florida.
SUMMARY: The proposed rulemaking: clarifies the purpose and scope of the department’s mental health services program; clarifies the provision of mental health services; updates definitions to reflect changes outlined in Chapter 2008-250, F.S.; clarifies the care and privileges of inmates in a mental health care setting; clarifies the criteria for admission to and release from mental health care settings; and repeals Rules 33-404.104, .105, .202, .203, .204, .205, .206, .207, .208, and .209 as the language of these rules is either duplicative or being moved to other rules within Chapter 33-404, F.A.C.
SUMMARY OF STATEMENT OF ESTIMATED REGULATORY COSTS: The agency has determined that these rules will not have an adverse impact on small business and are not likely to directly or indirectly increase regulatory costs in excess of $200,000 in the aggregate in this state within one year after implementation. A SERC has not been prepared by the agency.
Any person who wishes to provide information regarding a statement of estimated regulatory costs, or provide a proposal for a lower cost regulatory alternative must do so in writing within 21 days of this notice.
SPECIFIC AUTHORITY: 944.09, 945.48, 945.49 FS.
LAW IMPLEMENTED: 20.315, 120.55, 944.09, 944.11, 944.35, 945.21, 945.41-.49 FS.
IF REQUESTED WITHIN 21 DAYS OF THE DATE OF THIS NOTICE, A HEARING WILL BE SCHEDULED AND ANNOUNCED IN FAW.
THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE IS: Kendra Lee Jowers, 2601 Blair Stone Road, Tallahassee, Florida 32399-2500

THE FULL TEXT OF THE PROPOSED RULE IS:

33-404.101 Mental Health Services Program – Purpose and Scope.

(1) Mental health services are those services and activities that are provided primarily by mental health staff and secondarily by other health care staff, for the purposes of:

(a) Identifying inmates who are experiencing disabling symptoms of a mental disorder, that is, symptoms which impair the ability to function adequately within the incarceration environment; general inmate population.

(b) Providing appropriate timely intervention to alleviate for the purpose of alleviating disabling symptoms of a mental disorder;

(c) Assisting inmates the inmate with a mental disorder with adjusting to adjust to the demands of prison life;

(d) Assisting inmates the inmate with a mental disorder to maintain a level of adaptive personal and social functioning; and that will enable the inmate to remain in or be returned to the general inmate population.

(e) Providing mental health services to mentally retarded inmates who, though not mentally ill by definition, have problems related to their disabilities which impair their ability to function within the prison environment.

(e)(f) Providing re-entry mental health aftercare planning, and mental health education to facilitate the inmate’s continuity of follow-up care in the community and promote better mental health and overall adjustment after release to the community.

(2) Access to necessary mental Mental health services shall be available to all inmates within the department, shall be provided in a non-discriminatory fashion, and shall be provided in accordance with prevailing community and correctional standards of care.

(a) All inmates are eligible to receive mental health screening and or evaluation as necessary, precipitated by self or staff referral. Only the following persons are authorized to determine whether there is a need for mental health care: psychological specialist, registered nurse specialist, psychologist, senior psychologist, psychiatrist, or in their absence, by a nonpsychiatric physician.

(b) Priority for mental health treatment services shall be given to inmates who are experiencing or who are at risk for developing symptoms of mental disorder, which symptoms significantly impair ability to function adequately within the general inmate population.

(c) Inmates having or suspected of having a history of alcohol or drug abuse shall be referred to the department’s substance abuse treatment program. Inmates receiving substance abuse treatment are also eligible to receive mental health services.

(3) The department shall provide the following levels of mental health care:

(a) Outpatient; – which includes a broad range of evaluation and treatment services that are provided to inmates who reside within the general inmate population.

(b) Infirmary; Isolation Management – involves placement in an infirmary isolation management room, which has been designed to reduce the risk of self-harm or destruction of property.

(c) Transitional; – which is more intensive than outpatient care, but less intensive than crisis stabilization care, and is characterized by the provision of traditional mental health treatments in a structured residential setting.

(d) Crisis Stabilization; and – which includes a broad range of evaluation and treatment services that are provided within a highly structured, locked residential setting, intended for inmates who are experiencing acute emotional distress, and who cannot be adequately evaluated and treated in a transitional care unit or infirmary isolation management room.

(e) Corrections Mental Health Treatment Facility Care. Acute Psychiatric Care (at the hospital level) – which includes a broad range of evaluation and treatment services that are provided within a highly structured, secure, and locked hospital setting within a mental health treatment facility. Acute psychiatric care within a mental health facility requires prior judicial commitment to the facility, except for emergency admissions, which shall receive judicial review and commitment (if indicated) following admission.

(4) The rules of the Department of Corrections that are in effect shall be applicable to all departmental facilities that provide mental health services, except as modified by this Chapter, Rules 33-404.101-.108, and 33-404.201-.210, F.A.C., which are applicable to mental health treatment facilities.

(5) The Assistant Secretary for Health Services shall be the final authority for professional mental health care matters related to the care of inmates, including distribution of mental health resources, hiring and dismissal of mental health staff, and establishing relevant standards of care, policies, and procedures for all institutions.

(4)(6) Final medical responsibility and authority for mental health matters at the institutional level rest with the chief health officer Chief Health Officer or medical executive director Medical Executive Director, with support and oversight provided by the regional mental health consultant Regional Mental Health Consultant, Regional Health Services Director, director Director of mental health services Mental Health Services, and assistant secretary for health services the Chief of Health Services.

Rulemaking Specific Authority 944.09, 945.49 FS. Law Implemented 945.40-944.09, 945.49 FS. History–New 5-27-97, Formerly 33-40.001,_________.

 

33-404.102 Provision of Mental Health Services.

All inmates entering the department shall have access to necessary be entitled to receive mental health services as established by this chapter and as specified in the policies and procedures developed and implemented under the authority of the assistant secretary for health services. Assistant Secretary for Health Services. The Assistant Secretary for Health Services is the final authority for all health care related programs, policies, and procedures. The Assistant Secretary shall authorize policies, procedures, and service protocols deemed necessary and sufficient to establish guidelines for the delivery of mental health services. These service guidelines shall be disseminated to staff through health service bulletins, which shall be reviewed at least yearly, and revised as needed under the authority of the Assistant Secretary for Health Services. Health services bulletins shall be reviewed and revised periodically to ensure that constitutionally adequate mental health services are provided in accordance with applicable community and correctional standards.

(1) Inmates shall have access to mental health services commensurate with their needs as determined by health care staff.

(2) Inmates shall move within and between levels of care according to their level of adaptive functioning and treatment needs.

(3) All inmates who are receiving mental health services shall have an individualized services plan developed by mental health service providers.

(4) Inmates with diagnosed mental disorders shall have access to work, recreation, education, and other activities or opportunities which are commensurate with their ability that are available to those inmates not diagnosed with a mental disorder.

(5) Inmates who are assigned to administrative confinement, disciplinary confinement, protective management, or close management shall have access to necessary mental health care, interviews conducted by a mental health professional, initiated by self or staff, brief visits at cell front weekly to inquire as to whether the inmate has mental health problems; mental health evaluation and treatment as deemed necessary by health care staff; and scheduled individual and group appointments as indicated in an individualized services plan developed by mental health service providers.

(4)(6) Inmates who are assigned to administrative confinement under Rule 33-602.220, F.A.C, disciplinary confinement under Rule 33-602.222, F.A.C., protective management under Rule 33-602.221, or close management under Rule 33-601.800, F.A.C., or maximum management under Rule 33-601.820, F.A.C., and require necessary mental health services who report or display signs of rapid change in their mental or behavioral functioning, who exhibit bizarre behavior, or who exhibit or report thoughts or threats to harm themselves, shall be referred to mental health staff immediately, or to medical staff in the absence of mental health staff.

(5) The department shall establish a mental health classification system with which to identify inmates with a mental disorder that, in the clinical judgment of mental health staff, will adversely impact on the inmate’s ability to adapt to the incarceration environment. The classification system shall identify inmates according to their level of mental and adaptive functioning and treatment needs.

(6) Before mental health evaluation and treatment are rendered to an inmate, the provider of such services shall ask the inmate to give express and informed written consent, after the limits on confidentiality are explained, unless such consent is already documented. The explanation shall enable the inmate to make a voluntary decision without any element of fraud, deceit, duress, or any other form of constraint or coercion.

(7) If an inmate requires long-term involuntary treatment, the inmate shall be referred to a corrections mental health treatment facility in accordance with Rule 33-404.2095, F.A.C. All inmates serving a sentence for a sex offense shall be screened to identify those having a sexual disorder.

(8) Care of Inmates Receiving Mental Health Services. Rule 33-602.101, F.A.C., shall apply, and inmates receiving mental health services shall have the same privileges as other inmates unless mental health staff, in coordination with security staff, has determined that it is necessary to restrict an inmate’s privileges to prevent injury to the inmate or others.

(a) Clothing, health or comfort items, personal property, books, periodicals, and documents other than legal documents and legal mail may be removed if mental health staff determine that the inmate may cause harm to himself or others by the use thereof. Such property restrictions and the justifications therefor shall be documented in the inmate’s health record and reviewed at least every 72 hours to determine whether continuation of the restriction is necessary to prevent injury or harm to the inmate or others.

(b) An inmate’s telephone access, canteen privileges, outdoor exercise, and other movement may be restricted to prevent the inmate from harming himself or others. These restrictions and the reasons therefor shall be documented on the inmate’s health record and reviewed by mental health and security staff during the periodic review of the inmate’s risk assessment or more often as necessary due to changes in the inmate’s clinical, disciplinary, or management status.

(c) If it is determined that an inmate’s access to the law library must be restricted in order to prevent injury or harm to the inmate or others, security and mental health staff shall immediately notify the law librarian. The law librarian will coordinate with mental health and security staff to ensure that the inmate has access to necessary law library services, such as inmate law clerk visits, to ensure that the inmate meets any pending legal deadlines during the restriction. Mental health services shall be delivered using the least restrictive and intrusive methods possible to accomplish the desired objectives.

Rulemaking Specific Authority 944.09, 945.49 FS. Law Implemented 944.09, 945.48, 945.49 FS. History–New 5-27-97, Formerly 33-40.002,_________.

 

33-404.103 Mental Health Services – Definitions.

(1) For the purpose of this chapter, the position titles referenced in these rules are defined by class specifications of the Department of Management Services, pursuant to Chapter 110, F.S.

(2) “Medical Judgment” means opinions or determinations of a health care professional that directly affect or bear upon the health care status of inmates, and include diagnosis, treatment, allocation of mental health care resources and staff, quality and appropriateness monitoring, health education for staff and inmates, health care record-keeping, promulgation of health care policy and procedure, and hiring of professional health care staff.

(2)(3) “Mental Disorder” – means an impairment of the emotional processes, of the ability to exercise conscious control of one’s actions, or of the ability to perceive or understand reality that or to understand, which impairment substantially interferes with a person’s ability to meet the ordinary demands of the incarceration environment living, regardless of etiology, except that for the purposes of transfer of an inmate to a corrections mental health treatment facility, the term does not include retardation or developmental disability as those terms are defined in Chapter 393, F.S., simple intoxication, or conditions manifested only by antisocial behavior or drug addiction. An individual who is mentally retarded or developmentally disabled, however, may also have a mental disorder. A mental disorder, however, can exist in an individual who is retarded or developmentally disabled.

(3)(4) “Individualized Services Plan” – a written description of an inmate’s current problems, goals, and treatments “Mental Retardation” means significantly sub-average (IQ of 70 or below) general intellectual functioning as determined by assessment with one or more of the individually administered general intelligence tests, resulting in or associated with deficits or impairments in adaptive behavior, with onset before the age of 18.

(4)(5) “Mental Health Care (or Services)” – means observation, mental health assessment, psychological evaluation, or mental health treatment services that are delivered in in-patient or out-patient settings by a credentialed mental health staff professional, or other qualified physician. The in-patient settings include infirmary mental health services isolation rooms, transitional care units, crisis stabilization units, and or a corrections mental health treatment facilities facility. In-patient mental health care is indicated when necessary assessment or treatment services cannot be provided adequately or safely while the inmate resides in the general inmate population. Out-patient care is provided while the inmate resides in the general population.

(6) “Health Care Professional” means a member of the health care staff whose official duties include the provision of health care services to inmates.

(7) “Mental Health Staff” means a health care professional whose primary responsibility is the provision of mental health care to inmates.

(5)(8) “Corrections Mental Health Treatment Facility” – any extended treatment or hospitalization-level unit means the Corrections Mental Health Institution and any other institution that the assistant secretary Assistant Secretary for health services Health Services of the department specifically designates by Rule 33-404.201, F.A.C., to provide acute mental health psychiatric care and that may include involuntary treatment and therapeutic intervention hospital level, in contrast to less intensive levels of care such as out-patient mental health care, infirmary mental health care, transitional mental health care, or crisis stabilization care.

(6)(9) “Crisis Stabilization Care” – means a level of care that is less restrictive and intensive intense than care provided in a corrections mental health treatment facility that, and includes a broad range of evaluation and treatment services that are provided within a highly structured, locked residential setting. It is, intended for inmates who are experiencing debilitating symptoms of acute mental impairment emotional distress, and who cannot be adequately evaluated and treated in a transitional care unit or in infirmary mental health care isolation management room. Such treatment Treatment is also more intensive intense than in transitional care units as it is, being devoted principally toward rapid stabilization of acute symptoms and conditions.

(7)(10) “Infirmary Mental Health Care” – a level of care more intensive than outpatient care involving the observation and housing of inmates with identified risk of self-harm or acute deterioration in mental health functioning. “Personal Restraint” means the application of physical body pressure by another person, with or without a protective shield, to the body of an inmate in such a way as to limit or control his or her physical activity.

(8)(11) “Transitional Mental Health Care” – a level of care that is more intensive than outpatient and infirmary care but less intensive than crisis stabilization care, characterized by the provision of mental health treatment in the context of a structured residential setting. Transitional mental health care is indicated for a person with chronic or residual symptomology who does not require crisis stabilization care or placement in a corrections mental health treatment facility but whose impairment in functioning nevertheless renders him or her incapable of adaptive functioning within the incarceration environment. “Therapeutic Restraint” means a physical restraint technique to minimize movement in order to prevent self-harm or harm to others; in which an inmate’s limbs are secured by use of leather or vinyl cuffs, or straps. Therapeutic restraints may only be ordered by a health care staff member.

(9)(12) “Isolation Management Room” – means a cell room in an infirmary mental health care unit, transitional care unit, crisis stabilization unit, or a corrections mental health treatment facility that, which has been physically inspected and certified by a regional or central health care professional as being suitable for housing those with acute mental impairment acutely psychotic inmates or those who are at risk for self-injury.

(13) “Seclusion” means the supervised isolation of an inmate in a safe, empty (toilet or bed may or may not be included), locked room at a transitional care unit, or crisis stabilization unit, in order to reduce stimulation. The only purpose of seclusion is to enable an agitated inmate to regain control of his or her behavior, thereby protecting the inmate’s well-being as well as that of others. Seclusion may be continued only so long as its use is justified by the inmate’s clinical and behavioral status.

(14) “Time-out” means voluntary (whether or not requested by staff) withdrawal from a potentially stimulating situation by reporting to an unlocked room designated for that purpose at a transitional care unit, or crisis stabilization unit.

Rulemaking Specific Authority 944.09, 945.42, 945.49 FS. Law Implemented 944.09, 945.42, 945.49 FS. History–New 5-27-97, Formerly 33-40.003, Amended 10-19-03, .

 

33-404.104 Mental Health Services – Classification System.

The department shall establish a mental health classification system with which to identify inmates with a diagnosed mental disorder, or who appear to be at risk to develop a mental disorder that, in the clinical judgment of mental health staff will negatively impact on the inmate’s ability to adjust to the a general prison population. The classification system shall identify inmates according to their level of mental and adaptive functioning and treatment needs.

Rulemaking Specific Authority 944.09, 945.49 FS. Law Implemented 944.09, 945.49 FS. History–New 5-27-97, Formerly 33-40.004, Repealed_______. (See 33-404.102)

 

33-404.105 Consent to Mental Health Evaluation and Treatment.

(1) Before mental health evaluation, counseling, or psychotherapy is rendered to an inmate, the provider of such service shall ask the inmate to give written consent, after the limits on confidentiality are explained, unless such consent was given previously within 12 months. The explanation shall enable the inmate to make a knowing and willful decision without any element of fraud, deceit, or duress, or any other form of constraint or coercion.

(2) If an inmate refuses treatment that is deemed to be necessary for the inmate’s appropriate care and safety, such treatment may be provided under the following circumstances:

(a) In an emergency situation in which there is immediate danger to the health and safety of the inmate or others, such treatment shall be provided at any major institution, upon the written order of a physician for a period not to exceed 48 hours, excluding weekends and legal holidays, if no available lesser restrictive or intrusive intervention would be effective.

(b) If an inmate is unable to give express consent to mental health treatment and, in the professional judgment of the mental health care provider, such treatment is immediately necessary to preserve the inmate’s welfare, emergency mental health treatment shall be rendered.

(c) If an inmate requires long-term involuntary treatment, the inmate shall be referred to the Corrections Mental Health Institution in accordance with Section 945.48, F.S.

Rulemaking Specific Authority 944.09, 945.48, 945.49 FS. Law Implemented 944.09, 945.48, 945.49 FS. History–New 5-27-97, Formerly 33-40.005, Repealed_______. (See Rule 33-404.102)

 

33-404.106 Admission to Infirmary Mental Health Care Isolation Management, Transitional Care, or Crisis Stabilization.

(1) The right to refuse health care is inherent for all inmates committed to the custody of the department, except in cases in which refusal of care poses a serious threat to the inmate’s health or safety, or the health or safety of other inmates or staff.

(2) Admission to infirmary mental health care Placement in isolation management, crisis stabilization, or transitional care, when ordered by a qualified health care practitioner who is authorized to order such an admission by Health Services Bulletins may not be refused.

(3) An All required assessments or interventions shall be provided to the degree afforded by the inmate’s level of cooperation.

(4) The inmate’s refusal of evaluation or treatment, and all observations and assessments regarding the refusal shall be properly documented in the inmate’s health record.

Rulemaking Specific Authority 944.09, 945.49 FS. Law Implemented 944.09, 945.48, 945.49 FS. History–New 5-27-97, Formerly 33-40.006, .

 

33-404.201 Operation, Administration, and Designation of Corrections Mental Health Treatment Facilities.

(1) The department is responsible for the operation and administration of corrections mental health treatment facilities, the Corrections Mental Health Institution which are was established to provide for the treatment of inmates who have a mental disorder illness requiring intensive mental health psychiatric inpatient treatment at the hospital level. Since the Corrections Mental Health Institution may house both male and female inmates, security procedures shall be implemented governing inmate movement and control to prevent the co-mingling of male and female inmates.

(2) The assistant secretary Assistant Secretary for health services designates Health Services has also designated mental health treatment facilities at the following institutions:

(a) Union Correctional Institution;

(a)(b) Lake Correctional Institution (males);

(b)(c) Zephyrhills Correctional Institution (males); and

(d) South Florida Reception Center;

(e) Dade Correctional Institution;

(c)(f) Broward Correctional Institution (females); and

(g) Lowell Correctional Institution.

(3) The rules of the Department of Corrections shall be applicable to all Corrections Mental Health Treatment Facilities established by the department, except as modified by this chapter.

Rulemaking Specific Authority 944.09, 945.42, 945.49 FS. Law Implemented 944.09, 945.41, 945.42, 945.49 FS. History–New 11-3-85, Formerly 33-23.01, Amended 10-9-96, Formerly 33-23.001, Amended 10-19-03, .

 

33-404.202 Mental Health Treatment Facilities – Definitions.

For purposes of this rule, the following additional definitions shall apply:

(1) “Mental Health Treatment Facility,” pursuant to Section 945.42(7), F.S., means the Corrections Mental Health Institution and any other institution that the Assistant Secretary for Health Services of the department specifically designates by Rule 33-404.201, F.A.C., to provide acute psychiatric care at the hospital level for inmates requiring intensive psychiatric inpatient care and treatment, in contrast to less intensive levels of care such as outpatient mental health care, transitional mental health care, or crisis stabilization care.

(2) “Director for Mental Health Services” means a physician licensed pursuant to Chapter 458 or 459, F.S., or a psychologist licensed pursuant to Chapter 490, F.S., and employed by the department. “Director” as used herein means the Director for Mental Health Services.

(3) “Staff” means all personnel employed at a Corrections mental health facility, including contractual personnel and non-employed volunteers.

(4) “Mental Health Treatment Team” or “Treatment Team” means personnel who ensure that the inmates overall health care needs are met at Corrections mental health facilities.

(5) “Institutional Special Review Team” means the Assistant warden and Correctional Officer Chief of a Corrections mental health facility and a mental health professional or alternate staff members as appointed by the warden.

(6) “Mental Health Staff” means all persons employed at a Corrections mental health facility whose duties include the providing of mental health care and treatment for inmates.

(7) “Medical Executive Director” means the senior Corrections Mental Health Institution physician licensed pursuant to Chapter 458 or 459, F.S.

(8) “Physician” shall mean a physician or psychiatrist licensed pursuant to Chapter 458 or 459, F.S.

Rulemaking Specific Authority 944.09, 945.42, 945.49 FS. Law Implemented 20.315, 944.09, 945.42, 945.49 FS. History–New 11-3-85, Formerly 33-23.03, Amended 10-9-96, 3-24-97, 8-17-97, Formerly 33-23.003, Amended 10-19-03, Repealed_______. (See 33-404.103)

 

33-404.203 Mental Health Treatment Facilities – Care of Inmates.

The provisions of Rule 33-602.101, F.A.C., shall apply unless otherwise stated herein. The issue of clothing, health or comfort items may be restricted should clinical staff determine that the inmate may cause harm to himself or others by the use thereof.

Rulemaking Specific Authority 944.09, 945.49 FS. Law Implemented 944.09, 945.49 FS. History–New 11-3-85, Formerly 33-23.08, Amended 10-9-96, Formerly 33-23.008, Repealed_______. (See 33-404.102)

 

33-404.204 Mental Health Treatment Facilities – Use of Force.

The provisions of Rule 33-602.210, F.A.C., shall apply unless otherwise stated herein.

(1) Restraints shall not be used unless ordered by a physician, licensed psychologist, or registered nurse specialist with a counter-signature by a physician for orders issued by nonphysicians. Restraints shall not be used as a method of controlling inmates whose actions do not pose a threat of physical harm to themselves, others or property. The attending physician shall prepare a report documenting the factual basis upon which his decision to use restraints was made. Any force used to apply the restraints shall be documented in the physician’s report. The provisions of subsection 33-602.210(7), F.A.C., shall not be applicable whenever a physician or his designee orders the use of force or restraints for the purpose of administering medical, mental or dental health care to an inmate and said force is documented by the authorizing physician; therefore, it shall not be necessary for the physician to prepare a Report of Force Used.

(2) A physician or his designee shall examine and treat any injuries resulting from use of force or restraints in accordance with the provisions of subsection 33-602.210(7), F.A.C. It shall not be necessary for the physician to submit his report to the warden for investigation as required in subsection 33-602.210(7), F.A.C., if the use of force or restraints which resulted in the injury was pursuant to the orders of a physician or his designee. If a Report of Force Used is not required by the rules of the department, Forms DC4-701C and DC4-708 shall be filed in the medical record. Forms DC4-701C and DC4-708 have been incorporated by reference into subsection 33-602.210(8), F.A.C.

Rulemaking Specific Authority 944.09, 945.49 FS. Law Implemented 20.315, 944.09, 945.48, 945.49 FS. History–New 11-3-85, Formerly 33-23.10, Amended 10-9-96, Formerly 33-23.010, Repealed_______. (See 33-602.210)

 

33-404.205 Mental Health Treatment Facilities – Inmate Discipline.

The provisions of Rules 33-601.301-.314, F.A.C., shall apply unless otherwise stated herein. Disciplinary violations by an inmate shall be reviewed with treatment staff to determine if the inmate is responsible for his behavior prior to taking disciplinary action. The warden of a mental health treatment facility shall ensure that an institutional operating procedure is created governing the review for responsibility and treatment alternatives for those deemed not responsible. If it is determined that the inmate is not responsible for his behavior, disciplinary action shall not be taken. The single rooms which are available for medically ordered isolation shall be used also for inmates requiring disciplinary or administrative confinement. When an inmate is in administrative or disciplinary status, mental health treatment shall continue.

Rulemaking Specific Authority 944.09, 945.49 FS. Law Implemented 20.315, 944.09, 944.35, 945.48, 945.49 FS. History–New 11-3-85, Formerly 33-23.12, Amended 10-9-96, Formerly 33-23.012, Repealed_______. (See 33-404.108)

 

33-404.206 Mental Health Treatment Facilities – Administrative Confinement.

(1) The provisions of Rule 33-602.220, F.A.C., shall apply unless otherwise stated herein.

(2) When an inmate is placed in administrative confinement status for reasons outlined in Rule 33-602.220, F.A.C., the Senior Correctional Officer shall communicate the reasons for such placement to the senior mental health professional on duty who may recommend any additional supervision, observation or other treatment requirements for the inmate. The Senior Correctional Officer shall record any additional requirements in the Offender Based Information System (OBIS) electronic classification log. Staff shall be advised of any additional supervision or observation requirements and record this information in the inmate’s treatment chart and the Daily Record of Segregation Form DC6-229. Form DC6-229 has been incorporated by reference into subsection 33-602.220(10), F.A.C.

(3) When an inmate is placed in a single room for reasons of a medical or psychiatric nature, it will not be considered administrative confinement and attendant documentation is not required.

(4) Personal visits to inmates in administrative confinement will be made at least once a week by the Classification Team to determine whether a status change should be recommended.

Rulemaking Specific Authority 944.09, 945.49 FS. Law Implemented 20.315, 944.09, 944.35, 945.48, 945.49 FS. History–New 11-3-85, Formerly 33-23.13, 33-23.013, Amended 11-17-03, 11-17-03, Repealed________. (See 33-404.108)

 

33-404.207 Mental Health Treatment Facilities – Restrictions of Inmate Privileges.

(1) In addition to allowable restrictions as specified in Rule 33-602.221, F.A.C., the Treatment Team may, upon notification to the Senior Correctional Officer, cause restrictions to be effected when such would prevent an inmate from harming himself or others, or when it is determined to be therapeutic and consistent with the inmate’s treatment plan, including but not limited to telephone access, outdoor exercise, and canteen purchases. The Senior Correctional Officer shall ensure proper documentation of such restrictions as required by Rule 33-602.221, F.A.C. The Treatment Team initiating such action shall immediately notify the inmate of the reasons for restrictions and record such information in the inmate’s treatment chart.

(2) Those inmates whose behavior is characterized by recent violence, a continuing pattern of serious disciplinary behavior, behavior that seriously impacts negatively on the maintenance and control of the institution’s therapeutic environment, behavior interfering with staff efforts with the inmate and others which is not primarily due to a mental disorder, or involvement in acts which caused death or injury to others may be considered at any time for transfer to another institution. An individualized written treatment plan shall be developed so that the receiving institution may provide for continued mental health treatment.

Rulemaking Specific Authority 944.09, 945.49 FS. Law Implemented 944.09, 945.49 FS. History–New 11-3-85, Formerly 33-23.17, Amended 10-9-96, Formerly 33-23.017, Repealed_______. (See Rule 33-404.102)

 

33-404.208 Mental Health Treatment Facilities – Admissible Reading Material.

The provisions of Rule 33-501.401, F.A.C., shall apply herein unless otherwise stated. The inmate’s Treatment Team may restrict access to the library, books, newspapers or periodicals, with the exception of access to legal materials. Any restriction shall be consistent with the inmate’s Individualized Written Treatment Plan and justification for such restriction shall be documented in the inmate’s treatment record.

Rulemaking Specific Authority 944.11, 945.21, 945.49 FS. Law Implemented 944.11, 945.49 FS. History–New 11-3-85, Formerly 33-23.18, Formerly 33-23.018, Repealed_______. (See Rule 33-404.102)

 

33-404.209 Mental Health Treatment Facilities – Forms.

The following forms which are used in implementing the provisions of this chapter are hereby incorporated by reference:

(1) Form DC4-626, Petition and Certificate for Admission to the Corrections Mental Health Institution;

(2) Form DC4-627, Notice of Petition and Certificate for Admission to the Department of Corrections Mental Health Institution;

(3) Form DC4-628, Waiver of Hearing for Admission to the Department of Corrections Mental Health Institution;

(4) Form DC4-629, Request for Hearing After Initially Waiving This Right;

(5) Form DC4-630, Notification to Court of Inmate’s Action Regarding Hearing or Admission to the Department of Corrections Mental Health Institution;

(6) Form DC4-631, Notice of Hearing on Petition and Certificate for Admission to the Department of Corrections Mental Health Institution;

(7) Form DC4-632, Application for Attorney;

(8) Form DC4-633, Order for Admission to the Department of Corrections Mental Health Institution;

(9) Form DC4-634, Request for Order Authorizing Continued Admission to the Department of Corrections Mental Health Treatment Institution;

(10) Form DC4-635, Notice to Inmate of Request for Continued Admission to the Department of Corrections Mental Health Institution;

(11) Form DC4-636, Waiver of Hearing for Continued Admission to the Department of Corrections Mental Health Institution;

(12) Form DC4-637, Notice to Representative of Request for Continued Admission to the Department of Corrections Mental Health Institution;

(13) Form DC4-638, Notice of Hearing for Continued Admission to the Department of Corrections Mental Health Treatment Institution;

(14) Form DC4-639, Application for Attorney – Continued Admission;

(15) Form DC4-640, Order for Continued Admission to the Department of Corrections Mental Health Institution.

Copies of these forms may be obtained from the Corrections Mental Health Institution or from the Bureau of Health Services, Department of Corrections, 2601 Blair Stone Road, Tallahassee, Florida 32301. If forms are to be mailed, the request must be accompanied by a self-addressed stamped envelope. The effective date of these forms is November 3, 1985.

Rulemaking Specific Authority 945.21, 945.49 FS. Law Implemented 120.55, 945.21, 945.49 FS. History–New 11-3-85, Formerly 33-23.25, Formerly 33-23.025, Repealed________. (See Rules 33-404.2095 and .2098)

 

33-404.2095 Placement in Mental Health Treatment Facilities.

(1) An inmate shall be considered for placement in a corrections mental health treatment facility when he or she is in need of care and treatment as defined in Section 945.42, F.S.

(2) Placement in a corrections mental health treatment facility can only be made from a crisis stabilization unit and, except for emergencies as described in Rule 33-404.2096, F.A.C., all placements must be accompanied by a court order obtained in accordance with Section 945.43, F.S.

(3) The warden of the institution in which the crisis stabilization unit is housed shall recommend placement of an inmate in a corrections mental health treatment facility in accordance with Section 945.43, F.S.

Rulemaking Authority 944.09, 945.49 FS. Law Implemented 945.42, 945.43 FS. History–New .

 

33-404.2096 Emergency Placement in Mental Health Treatment Facilities.

An inmate who has a mental disorder and is in immediate need of care and treatment as defined in Section 945.42(5), F.S., that cannot be provided at the institution where the inmate is currently housed may be placed in a corrections mental health treatment facility in accordance with Section 945.44, F.S.

Rulemaking Authority 944.09, 945.49 FS. Law Implemented 945.42, 945.44 FS. History–New .

 

33-404.2097 Discharge from Mental Health Treatment Facilities

When an inmate is no longer in need of care and treatment as defined in Section 945.42(6), F.S., he or she shall be discharged from a corrections mental health treatment facility to a transitional care unit for at least thirty days prior to being transferred to a less restrictive setting.

Rulemaking Authority 944.09, 945.49 FS. Law Implemented 945.42, 945.47 FS. History–New .

 

33-404.2098 Continued Placement in Mental Health Treatment Facilities.

(1) An inmate may be retained in a corrections mental health treatment facility if he or she has a mental disorder and continues to be in need of care and treatment as defined in Section 945.42(6), F.S.

(2) In accordance with Section 945.45, F.S., the warden of the institution where the corrections mental health treatment facility is located shall file a petition with the Division of Administrative Hearings for an order authorizing continued placement of an inmate in the facility prior to the expiration of the period during which the facility is authorized to retain the inmate.

Rulemaking Authority 944.09, 945.49 FS. Law Implemented 945.42, 945.45 FS. History–New .

 

33-404.210 Corrections Mental Health Treatment Facilities – Consent to Psychiatric Treatment.

(1) Before psychiatric treatment is initiated within a corrections mental health treatment facility as defined in Rule 33-404.103 subsection 33-404.202(2), F.A.C., the inmate shall be asked to give his express and informed written consent for such treatment in accordance with Section 945.48, F.S “Express and informed written consent” means consent voluntarily given in writing after a conscientious and sufficient explanation and disclosure of:

(a) The purpose of the proposed treatment;

(b) The common side effects of the treatment, if any;

(c) The expected duration of the treatment; and

(d) The alternative treatment available.

The explanation shall enable the inmate to make a knowing and willful decision without any element of fraud, deceit, or duress, or any other form of constraint or coercion.

(2) If the inmate is placed a patient in a corrections mental health treatment facility by order of a court and refuses such treatment as is deemed to be necessary for the appropriate care and safety of the inmate or others, such treatment may be provided under the following circumstances:

(a) In an emergency situation in which there is immediate danger to the health and safety of the inmate or other inmates, such treatment may be provided upon the written order of a physician for a period not to exceed 48 hours, excluding weekends and legal holidays. If, after the 48-hour period, the inmate has not given express and informed consent to the treatment initially refused, the warden shall, within 48 hours, excluding weekends and legal holidays, petition the circuit court serving the county in which the facility is located for an order authorizing the continued treatment of the inmate. In the interim, treatment may be continued upon the written order of a physician who has determined that the emergency situation continues to present a danger to the safety of the inmate or others.

(b) In a situation other than an emergency situation, the warden shall petition the circuit court serving the county in which the corrections mental health treatment facility is located for an order authorizing the treatment of the inmate in accordance with Section 945.48, F.S for a 90 day period. The court shall be notified in writing if the inmate has provided express and informed consent in writing; has been transferred to another institution of the department is no longer in need of treatment the warden shall, prior to the expiration of the initial 90-day order, petition the court for an order authorizing the continuation of treatment for another 90-day period. This procedure shall be repeated until the inmate provides consent, is no longer at the mental health treatment facility, or is no longer in need of treatment. Treatment may be continued pending a hearing after the filing of any petition. The inmate and his representative shall be provided with a copy of the petition and the date, time, and location of the hearing.

(3) When In addition to the above provisions, when the consent permission of the inmate cannot be obtained, the warden of a mental health treatment facility or his designee, with the concurrence of the inmate’s attending physician, may authorize emergency surgical or non-psychiatric medical treatment if such treatment is deemed lifesaving or if there is a situation threatening serious bodily harm to the inmate.

Rulemaking Specific Authority 944.09, 945.49 945.48 FS. Law Implemented 945.48 FS. History–New 4-30-91, Formerly 33-23.026, Amended________.

NAME OF PERSON ORIGINATING PROPOSED RULE: Dean Aufderheide, Director of Mental Health Services
NAME OF AGENCY HEAD WHO APPROVED THE PROPOSED RULE: Richard Davison, Deputy Secretary
DATE PROPOSED RULE APPROVED BY AGENCY HEAD: November 17, 2009
DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAW: December 18, 2009