PURPOSE AND EFFECT: Through this promulgation, the Department is proposing rules that will implement the Legislature’s expansion of the scope of practice of psychiatric nurses and will revise and adopt forms used in the management and documentation ...

 

DEPARTMENT OF CHILDREN AND FAMILIES

Mental Health Program

RULE NOS.:RULE TITLES:

65E-5.1301Transfer Evaluations for Admission to State Mental Health Treatment Facilities from Receiving Facilities

65E-5.170Right to Express and Informed Consent

65E-5.2801Minimum Standards for Involuntary Examination Pursuant to Section 394.463, F.S

65E-5.285Involuntary Outpatient Placement

65E-5.290Involuntary Inpatient Placement

PURPOSE AND EFFECT: Through this promulgation, the Department is proposing rules that will implement the Legislature’s expansion of the scope of practice of psychiatric nurses and will revise and adopt forms used in the management and documentation of examination, treatment, and firearms restrictions imposed on persons who receive voluntary or involuntary mental health examinations. The Department intends to amend: (1) Rules 65E-5.1303 and 65E-5.2801, F.A.C., to authorize psychiatric nurses to perform involuntary examinations and to require psychiatric nurses to notify community aftercare providers or other entities responsible for dispensing or administering medication of a patient’s release from a mental health treatment facility; (2) Rule 65E-5.170, F.A.C., to incorporate by reference revised versions of forms: (a) CF-MH 3032, “Petition for Involuntary Inpatient Placement;” (b) CF-MH 3130, “Petition for Involuntary Outpatient Placement;” and (c) CF-MH 3104, “Certification of Person’s Competence to Provide Express and Informed Consent;” (3) Rule 65E-5.2801, F.A.C., to incorporate language that requires proof that a person has acknowledged, in writing, his or her understanding that he or she may be prohibited from purchasing a firearm or may have to surrender or may be prohibited from obtaining a concealed weapons license as a result of an involuntary inpatient or outpatient placement in a mental health facility. This rule revision incorporates a new form, CF-MH 3186, “Patient’s Notice and Acknowledgment–Purchase of Firearms and Application for or Retention of a Concealed Weapons or Firearms License;” (4) Rules 65E-5.285 and 65E-5.290, F.A.C., to incorporate by reference a revised version of CF-MH 3114, “Order Requiring Involuntary Assessment and Stabilization for Substance Abuse and for Baker Act Discharge of Person,” and CF-MH 3115, “Order Requiring Evaluation for Involuntary Outpatient Placement,” respectively. Both rules are amended to cross reference the newly created notice and acknowledgment form, CF-MH 3186, “Patient’s Notice and Acknowledgment—Purchase of Firearms and Application for or Retention of a Concealed Weapons Firearms License.”

SUBJECT AREA TO BE ADDRESSED: Mental Health Act Regulation

RULEMAKING AUTHORITY: 394.457(5), 394.46715 FS.

LAW IMPLEMENTED: 394.455(9), (14), (15), (18), (23), 394.459(3), 394.4599, 394.4625(1)(f), 394.463, 394.463(2)(e), 394.4655, 394.4655(2)(a), 394.467, 395, 397.675, 458.325, 765.401 FS.

IF REQUESTED IN WRITING AND NOT DEEMED UNNECESSARY BY THE AGENCY HEAD, A RULE DEVELOPMENT WORKSHOP WILL BE NOTICED IN THE NEXT AVAILABLE FLORIDA ADMINISTRATIVE REGISTER.

THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE DEVELOPMENT AND A COPY OF THE PRELIMINARY DRAFT, IF AVAILABLE, IS: Wanda Carter, 1317 Winewood Boulevard, Building 6, Tallahassee, Florida 32399-0700, [e-mail]

 

THE PRELIMINARY TEXT OF THE PROPOSED RULE DEVELOPMENT IS:

 

65E-5.1303 Discharge from Receiving and Treatment Facilities.

(1) through (5) No change.

(6) On the day of discharge from a state mental health treatment facility, the referring physician, or his or her designee, or a psychiatric nurse, within the requirements of Sections Section 394.455, 394.4615, and 394.463, F.S., and the policies and procedures required by subsection (4) of this rule, shall immediately notify the community aftercare provider or entity responsible for dispensing or administering medications. Recommended form CF-MH 7002, Feb. 05, “Physician to Physician Transfer,” as referenced in subsection 65E-5.1302(2), F.A.C., may be used for this purpose, and may be obtained online at https://www.flrules.org/Gateway/reference.asp?No=Ref-02362, http://www.myflfamilies.com/service-programs/mental-health/baker-act-forms.

Rulemaking Authority 394.457(5), 394.46715, FS. Law Implemented 394.4573, 394.459(11), 394.460, 394.463(2), FS. History–New 11-29-98, Amended 4-4-05, 4-9-13,           .

 

65E-5.170 Right to Express and Informed Consent.

(1) Establishment of Consent

(a) through (b) No change.

(c) If the admission is voluntary, the person’s competence to provide express and informed consent for admission shall be documented by the admitting physician. Recommended form CF-MH 3104, March 2015 Feb. 05, “Certification of Person’s Competence to Provide Express and Informed Consent,” which is incorporated by reference and may be obtained pursuant to Rule 65E-5.120, F.A.C., of this rule chapter may be used for this purpose. The completed form or other documentation shall be retained in the person’s clinical record. Facility staff monitoring the person’s condition shall document any observations which suggest that a person may no longer be competent to provide express and informed consent to his or her treatment. In such circumstances, staff shall notify the physician and document in the person’s clinical record that the physician was notified of this apparent change in clinical condition.

(d) In the event there is a change in the ability of a person on voluntary status to provide express and informed consent to treatment, the change shall be immediately documented in the person’s clinical record. A person’s refusal to consent to treatment is not, in itself, an indication of incompetence to consent to treatment.

1. If the person is assessed to be competent to consent to treatment and meets the criteria for involuntary inpatient placement, the facility administrator shall file with the court a petition for involuntary placement. Recommended form CF-MH 3032, March 2015 Feb. 05, “Petition for Involuntary Inpatient Placement,” which is incorporated by reference and may be obtained pursuant to Rule 65E-5.120, F.A.C., of this rule chapter may be used for this purpose.

2. If the person is assessed to be incompetent to consent to treatment, and meets the criteria for involuntary inpatient or involuntary outpatient placement, the facility administrator shall expeditiously file with the court both a petition for the adjudication of incompetence to consent to treatment and appointment of a guardian advocate, and a petition for involuntary inpatient or involuntary outpatient placement. Upon determination that a person is incompetent to consent to treatment the facility shall expeditiously pursue the appointment of a duly authorized substitute decision-maker that can make legally required decisions concerning treatment options or refusal of treatments for the person. Recommended forms CF-MH 3106, Feb. 05, “Petition for Adjudication of Incompetence to Consent to Treatment and Appointment of a Guardian Advocate,” which is incorporated by reference may be obtained pursuant to Rule 65E-5.120, F.A.C., of this rule chapter, and CF-MH 3032, “Petition for Involuntary Inpatient Placement,” as referenced in subparagraph 65E-5.170(1)(d)1., F.A.C., or CF-MH 3130, March 2015, “Petition for Involuntary Outpatient Placement,” which is incorporated by reference and may be obtained pursuant to Rule 65E-5.120, F.A.C., of this rule chapter may be used for this purpose.

(e) through (i) No change.

(2) through (7) No change.

Rulemaking Specific Authority 394.457(5), 394.46715, FS. Law Implemented 394, Part I, 394.455(9), (14), (15), 394.459(3), 394.4625(1)(f), 394.4655, 458.325, 765.401, FS. History–New 11-29-98, Amended 4-4-05,          .

 

65E-5.2801 Minimum Standards for Involuntary Examination Pursuant to Section 394.463, F.S.

The involuntary examination is also known as the initial mandatory involuntary examination.

(1) Whenever an involuntary examination is initiated by a circuit court, a law enforcement officer, or a mental health professional as provided in Section 394.463(2), F.S., an examination by a physician, psychiatric nurse, or clinical psychologist must be conducted and documented in the person’s clinical record. The examination, conducted at a facility licensed under Chapter 394 or 395, F.S., must contain:

(a) A thorough review of any observations of the person’s recent behavior;

(b) A review of mandatory form CF-MH 3100, “Transportation to Receiving Facility,” as referenced in subsection 65E-5.260(2), F.A.C., and recommended form CF-MH 3001, “Ex Parte Order for Involuntary Examination,” as referenced in subsection 65E-5.260(1), F.A.C., or other form provided by the court, or mandatory form CF-MH 3052a, “Report of Law Enforcement Officer Initiating Involuntary Examination,” as referenced in subsection 65E-5.260(1), F.A.C., or mandatory form CF-MH 3052b, “Certificate of Professional Initiating Involuntary Examination,” as referenced in subsection 65E-5.260(1), F.A.C.

(c) A brief psychiatric history; and

(d) A face-to-face examination of the person in a timely manner to determine if the person meets criteria for release.

(2) through (7) No change.

(8) Disposition Upon Initial Mandatory Involuntary Examination.

(a) through (b) No change.

(c) A person for whom an involuntary examination has been initiated shall not be permitted to consent to voluntary admission until after examination by a physician to confirm his or her ability to provide express and informed consent to treatment and has proven to not be an imminent danger to himself or herself or others. Recommended form CF-MH 3104, “Certification of Person’s Competence to Provide Express and Informed Consent,” as referenced in paragraph 65E-5.170(1)(c), F.A.C., may be used for documentation.

(d) If the facility administrator, based on facts and expert opinions, believes the person meets the criteria for involuntary inpatient or involuntary outpatient placement or is incompetent to consent to treatment, the facility shall initiate involuntary placement within 72 hours of the person’s arrival by filing a petition for involuntary placement. Recommended form CF-MH 3032, “Petition for Involuntary Inpatient Placement,” as referenced in subparagraph 65E-5.170(1)(d)1., F.A.C., or CF-MH 3130, “Petition for Involuntary Outpatient Placement” as referenced in subparagraph 65E-5.170(1)(d)2., F.A.C., may be used for this purpose. Such petition shall be signed by the facility administrator or designee within the 72-hour examination period. The petition shall be filed with the court within the 72-hour examination period or, if the 72 hours ends on a weekend or legal holiday, no later than the next court working day thereafter. A copy of the completed petition and proof that the person has acknowledged, in writing, a potential prohibition from purchasing a firearm notice, pursuant to s. 790.065, F.S., shall be retained in the person’s clinical record and a copy given to the person and his or her duly authorized legal decision-maker or representatives. Form CF-MH 3186, March 2015, “Patient’s Notice and Acknowledgment – Purchase of Firearms and Application for or Retention of a Concealed Weapons Firearms License,” which is incorporated by reference and may be obtained pursuant to Rule 65E-5.120, F.A.C., may be used for this purpose.

(e) No Change.

Rulemaking Specific Authority 394.457(5), 394.46715, FS. Law Implemented 394, 394.463, 394.463(2), 394.4655, 395, FS. History–New 11-29-98, Amended 4-4-05,          .

 

65E-5.285 Involuntary Outpatient Placement.

(1) No change.

(2) Hearing on Petition for Involuntary Outpatient Placement.

(a) through (e) No change.

(f) If the court determines the person meets the criteria for involuntary assessment, protective custody, or involuntary admission pursuant to Section 397.675, F.S., and issues an order for one of the same, recommended form CF-MH 3114, March 2015 Feb. 05, “Order Requiring Involuntary Assessment and Stabilization for Substance Abuse and for Baker Act Discharge of Person,” which is incorporated by reference and may be obtained pursuant to Rule 65E-5.120, F.A.C., of this rule chapter, or other order entered by the court, may be used.

(3) Court Order.

(a) If the court concludes that the person meets the criteria for involuntary outpatient placement pursuant to Section 394.4655, F.S., it shall prepare an order. Recommended form CF-MH 3155, Feb. 05, “Order for Involuntary Outpatient Placement or Continued Involuntary Outpatient Placement,” which is incorporated by reference and may be obtained pursuant to Rule 65E-5.120, F.A.C., of this rule chapter, or other order entered by the court, may be used for this purpose. This signed order shall be given to the person, guardian, guardian advocate or representative, counsel for the person, state attorney, and administrator of the receiving or treatment facility, with a copy of the order retained in the person’s clinical record. A copy of the proof that the person has acknowledged, in writing, receipt of notice that he or she may be prohibited from purchasing a firearm or may be required to surrender or can be denied a concealed weapons license, pursuant to s. 790.065, F.S., shall also be retained in the person’s clinical record. Form CF-MH 3186, “Patient’s Notice and Acknowledgment – Purchase of Firearms and Application for or Retention of a Concealed Weapons Firearms License,” as referenced in Rule 65E-5.2801 and may be obtained pursuant to Rule 65E-5.120, F.A.C., may be used for this purpose.

Rulemaking Authority 394.46715, FS. Law Implemented 394.455, 394.455(18), 394.4599, 394.463, 394.4655, 394.4655(2)(a), 397.675, FS. History– New 4-4-05, Amended 1-8-07,          .

 

65E-5.290 Involuntary Inpatient Placement.

(1) through (6) No change.

(7) If the court determines the person meets the criteria for involuntary assessment, protective custody, or involuntary admission pursuant to Section 397.675, F.S., and issues an order, recommended form CF-MH 3114, March 2015 Feb. 05, “Order Requiring Involuntary Assessment and Stabilization for Substance Abuse and for Baker Act Discharge of Person,” as referenced in paragraph 65E-5.285(2)(g), F.A.C., or other order issued used by the court, may be used for this purpose.

(8) If at any time prior to the conclusion of the hearing on involuntary inpatient placement, the person instead meets the criteria for involuntary outpatient placement, the court may order the person evaluated for involuntary outpatient placement. Recommended form CF-MH 3115, March 2015 Feb. 05, “Order Requiring Evaluation for Involuntary Outpatient Placement,” which is incorporated by reference and may be obtained pursuant to Rule 65E-5.120, F.A.C., of this rule chapter, or other order adopted by the court, may be used.

(9) If the court concludes that the person meets the criteria for involuntary inpatient placement pursuant to Section 394.467, F.S., it shall prepare an order. Recommended form CF-MH 3008, “Order for Involuntary Inpatient Placement,” as referenced in paragraph 65E-5.1302(1)(b), F.A.C., or other order used by the court, may be used for this purpose. This signed order shall be given to the person, guardian, guardian advocate or representative, counsel for the person, state attorney, and administrator of the receiving or treatment facility, with a copy of the order retained in the person’s clinical record. A copy of the proof that the person has acknowledged, in writing, receipt of notice that he or she may be prohibited from purchasing a firearm or may be required to surrender or can be denied a concealed weapons license, pursuant to s. 790.065, F.S., shall also be retained in the person’s clinical record. Form CF-MH 3186, “Patient’s Notice and Acknowledgment – Purchase of Firearms and Application for or Retention of a Concealed Weapons Firearms License,” as referenced in Rule 65E-5.2801 and may be obtained pursuant to Rule 65E-5.120, F.A.C., may be used for this purpose.

(10) No change.

Rulemaking Authority 394.457(5), 394.46715, FS. Law Implemented 394.463(2)(e), 394.467, 397.675, FS. History–New 11-29-98, Amended 4-4-05, 1-8-07,          .