11

Marchman ActMarchman ActThe Florida The Florida

Substance Abuse Substance Abuse

Impairment ActImpairment Act

22

History of the Marchman ActHistory of the Marchman Act

Myers Act (396, FS)Myers Act (396, FS)

Drug Dependency Act (397, FS)Drug Dependency Act (397, FS)

Hal S. Marchman Alcohol & Other Drug Services Hal S. Marchman Alcohol & Other Drug Services Act of 1993 -- addresses the entire array of Act of 1993 -- addresses the entire array of substance abuse impairment issues.substance abuse impairment issues.

Not just the substance abuse version of the Baker Not just the substance abuse version of the Baker Act!!Act!!

33

Legislative IntentLegislative Intent

Substance Abuse is a major health problem Substance Abuse is a major health problem leading to:leading to:– Serious impairmentSerious impairment– Chronic addictionChronic addiction– Criminal behaviorCriminal behavior– Vehicular casualtiesVehicular casualties– Spiraling health care costsSpiraling health care costs– HIV/AIDSHIV/AIDS– Business lossesBusiness losses– Children’s learning abilityChildren’s learning ability– Family dysfunctionFamily dysfunction

44

Substance Abuse DefinedSubstance Abuse Defined

Substance Abuse means:Substance Abuse means:

Use of any substance if such use is Use of any substance if such use is unlawful unlawful oror

If such use is detrimental to the user If such use is detrimental to the user or to others, but is not unlawful.or to others, but is not unlawful.

55

Substance Abuse Impairment Substance Abuse Impairment DefinedDefined

A condition involving the use of alcohol or any A condition involving the use of alcohol or any

psychoactive or mood-altering substance in such a psychoactive or mood-altering substance in such a

manner as to induce:manner as to induce:

mental, mental,

emotional, or emotional, or

physical problems physical problems

And cause socially dysfunctional behaviorAnd cause socially dysfunctional behavior

66

Service Providers DefinedService Providers Defined

Public agencies, Public agencies,

Private for-profit or not-for-profit agencies, Private for-profit or not-for-profit agencies,

Specified private practitioners, and Specified private practitioners, and

Hospitals Hospitals

that are DCF licensed that are DCF licensed or exemptor exempt from licensure from licensure under the Marchman Act.under the Marchman Act.

77

Service DefinitionsService Definitions

Hospital Hospital – Licensed by AHCA under chapter 395, – Licensed by AHCA under chapter 395, FSFS

Detox CenterDetox Center – uses medical and psychological – uses medical and psychological procedures and supportive counseling to manage procedures and supportive counseling to manage toxicity and withdrawing/stabilizing from effects of toxicity and withdrawing/stabilizing from effects of substance abuse.substance abuse.

Addiction Receiving Facility (ARF)Addiction Receiving Facility (ARF) –state –state contracted and designated secure facility contracted and designated secure facility providing intensive level of care capable of providing intensive level of care capable of handling aggressive behavior/deter elopements handling aggressive behavior/deter elopements for persons meeting involuntary for persons meeting involuntary assessment/treatmentassessment/treatment

88

Admission TypesAdmission Types

I. Voluntary AdmissionsI. Voluntary Admissions

II. Involuntary Admissions:II. Involuntary Admissions:

Non-Court Involved:Non-Court Involved:– Protective CustodyProtective Custody– EmergencyEmergency

Alternative Involuntary Assessment for Alternative Involuntary Assessment for minorsminors

Court Involved:Court Involved:– Involuntary Assessment/StabilizationInvoluntary Assessment/Stabilization– Involuntary TreatmentInvoluntary Treatment

99

All Admissions Provider ResponsibilitiesAll Admissions Provider Responsibilities

Any person, including minors, may apply for Any person, including minors, may apply for voluntary voluntary admission.admission.

Person must be admitted when sufficient evidence Person must be admitted when sufficient evidence exists that:exists that:– Person is SA impairedPerson is SA impaired– Setting Is the least restrictive and appropriateSetting Is the least restrictive and appropriate– Within licensed censusWithin licensed census– Medical & behavioral condition can be safely Medical & behavioral condition can be safely

managedmanaged– Within financial means of personWithin financial means of person

1010

Provider ResponsibilitiesProvider Responsibilities

Persons involuntarily placed only in licensed Persons involuntarily placed only in licensed service providers in components authorized to service providers in components authorized to accept involuntary clients.accept involuntary clients.

Providers accepting person on involuntary statusProviders accepting person on involuntary status must provide a description of the eligibility and must provide a description of the eligibility and diagnostic criteria and the placement process to diagnostic criteria and the placement process to be followed for each of the involuntary be followed for each of the involuntary

placement proceduresplacement procedures decision to refuse to admit or to discharge shall decision to refuse to admit or to discharge shall

be made only by a qualified professional.be made only by a qualified professional.

1111

Non-Discriminatory ServicesNon-Discriminatory Services

Access cannot be denied based on race, gender, Access cannot be denied based on race, gender,

ethnicity, age, sexual preference, HIV status, ethnicity, age, sexual preference, HIV status,

disability, use of prescribed medications, prior disability, use of prescribed medications, prior

service departures against medical advice, or service departures against medical advice, or

number of relapse episodes.number of relapse episodes.

Publicly funded providers cannot deny access to Publicly funded providers cannot deny access to

services based solely on inability to pay , if space services based solely on inability to pay , if space

and state resources are available.and state resources are available.

1212

Non-AdmissionNon-AdmissionProvider ResponsibilitiesProvider Responsibilities

If not admitted & consistent with federal If not admitted & consistent with federal confidentiality, must attempt contact with the confidentiality, must attempt contact with the referral source to discuss the circumstances and referral source to discuss the circumstances and assist in arranging for alternative interventions.assist in arranging for alternative interventions.

If unable to reach referral source, provider must If unable to reach referral source, provider must refuse admission and attempt to assist person in refuse admission and attempt to assist person in gaining access to other appropriate services.gaining access to other appropriate services.

Report within 1 workday in writing to referral Report within 1 workday in writing to referral source, the basis of refusal and efforts made to source, the basis of refusal and efforts made to contact referral source and assist person.contact referral source and assist person.

1313

Client Responsibility for Client Responsibility for Cost of ServicesCost of Services

Must have a fee system based upon a client’s Must have a fee system based upon a client’s ability to pay, and if space and sufficient state ability to pay, and if space and sufficient state resources are available, may not deny a client resources are available, may not deny a client access to services solely on the basis of client’s access to services solely on the basis of client’s inability to pay.inability to pay.

Full charge & fee charged must be disclosed to Full charge & fee charged must be disclosed to clientclient

Client (or guardian of minor) required to Client (or guardian of minor) required to contribute toward costs, based on ability to paycontribute toward costs, based on ability to pay

Guardian of minor not liable if services provided Guardian of minor not liable if services provided without parent consent unless guardian ordered without parent consent unless guardian ordered to payto pay

1414

Involuntary Admissions CriteriaInvoluntary Admissions Criteria

Good faith reason to believe person is Good faith reason to believe person is substance abuse impaired and because of substance abuse impaired and because of the impairment:the impairment:

Has lost power of self-control over Has lost power of self-control over substance use; substance use; and eitherand either::

1515

Involuntary Admission CriteriaInvoluntary Admission Criteria

Has inflicted, or threatened or attempted to inflict, Has inflicted, or threatened or attempted to inflict, or unless admitted is likely to inflict, physical harm or unless admitted is likely to inflict, physical harm on self or others, on self or others, oror

Is in need of substance abuse services and, by Is in need of substance abuse services and, by reason of substance abuse impairment, his/her reason of substance abuse impairment, his/her judgment has been so impaired the person is judgment has been so impaired the person is incapable of appreciating the need for services and incapable of appreciating the need for services and of making a rational decision in regard thereto. of making a rational decision in regard thereto. (Mere refusal to receive services not evidence of (Mere refusal to receive services not evidence of lack of judgment)lack of judgment)

1616

Non-Court Involved AdmissionsNon-Court Involved Admissions

Protective CustodyProtective Custody

EmergencyEmergency

Alternative Involuntary Alternative Involuntary Assessment for MinorsAssessment for Minors

1717

Protective CustodyProtective Custody

Law enforcement may implement for adults or Law enforcement may implement for adults or minors when involuntary admission criteria appears minors when involuntary admission criteria appears to be met.to be met.

Who is in a public place Who is in a public place oror is brought to attention of is brought to attention of LEO.LEO.

Person may Person may consentconsent to LEO assistance to home, to LEO assistance to home, hospital, licensed detox center, or addictions hospital, licensed detox center, or addictions receiving facility, whichever the LEO determines is receiving facility, whichever the LEO determines is most appropriate.most appropriate.

1818

Protective CustodyProtective CustodyWithoutWithout Consent Consent

Law enforcement officer may take person Law enforcement officer may take person to a:to a: Hospital, Hospital, Detox Center, or Detox Center, or ARF, ARF, or or

An An adultadult may be taken to jail. This is may be taken to jail. This is not an arrest and no record is made.not an arrest and no record is made.

1919

Jail ResponsibilityJail Responsibility

Jail must notify nearest appropriate licensed Jail must notify nearest appropriate licensed provider within 8 hours and shall arrange provider within 8 hours and shall arrange transport to provider with an available bed.transport to provider with an available bed.

Must be assessed by jail’s attending physician Must be assessed by jail’s attending physician without unnecessary delay but within 72-hours without unnecessary delay but within 72-hours

2020

Protective CustodyProtective Custody

Must be released by a qualified professional* when:Must be released by a qualified professional* when:

Client no longer meets the involuntary admission Client no longer meets the involuntary admission criteria, criteria, oror

The 72-hour period has elapsed; orThe 72-hour period has elapsed; or Client has consented to remain voluntarily, Client has consented to remain voluntarily, oror Petition for involuntary assessment or treatment Petition for involuntary assessment or treatment

has been initiated. Timely filing of petition has been initiated. Timely filing of petition authorizes retention of client pending further order authorizes retention of client pending further order of the court.of the court.

2121

Qualified Professional DefinedQualified Professional Defined

Physician licensed under 458 or 459;Physician licensed under 458 or 459; Professional licensed under chapter 490 or 491 Professional licensed under chapter 490 or 491

(Psychologist, Clinical SW, Marriage & Family (Psychologist, Clinical SW, Marriage & Family Therapist or Mental Health Counselor); orTherapist or Mental Health Counselor); or

Person who is certified through a DCF recognized Person who is certified through a DCF recognized certification process for substance abuse certification process for substance abuse treatment services and who holds, at a minimum, treatment services and who holds, at a minimum, a bachelor’s degree.a bachelor’s degree.

Reciprocity with other states – meet Florida Reciprocity with other states – meet Florida requirements within 1 year.requirements within 1 year.

Grandfather – certified in Florida prior to 1/1/95.Grandfather – certified in Florida prior to 1/1/95.

2222

Emergency AdmissionsEmergency Admissions

A person meeting involuntary admission criteria may A person meeting involuntary admission criteria may be admitted to:be admitted to:

A hospital, A hospital, A licensed detox, or A licensed detox, or An ARF An ARF

for emergency assessment and stabilization upon for emergency assessment and stabilization upon receipt of a receipt of a physician’sphysician’s certificatecertificate and completion of and completion of an an application.application.

2323

Emergency AdmissionEmergency AdmissionInitiationInitiation

An application for emergency admission may be An application for emergency admission may be initiated:initiated:

For a For a minorminor by the parent, guardian or legal by the parent, guardian or legal custodian. custodian.

For For adultsadults:: Certifying physicianCertifying physician Spouse or guardianSpouse or guardian Any relativeAny relative Any other responsible adult who has personal Any other responsible adult who has personal

knowledge of the person’s substance abuse knowledge of the person’s substance abuse impairment.impairment.

2424

Physician’s CertificatePhysician’s Certificate

Physician’s Certificate must include:Physician’s Certificate must include: Name of clientName of client

Relationship between client and physicianRelationship between client and physician

Relationship between physician and providerRelationship between physician and provider

Statement that exam & assessment occurred Statement that exam & assessment occurred within 5 days of application date, within 5 days of application date, andand

2525

Physician’s CertificatePhysician’s Certificate

Factual allegations about the need for emergency Factual allegations about the need for emergency admission:admission:

Reasons for physician’s belief the person meets Reasons for physician’s belief the person meets each criteria for involuntary admissioneach criteria for involuntary admission

Must recommend the least restrictive type of Must recommend the least restrictive type of serviceservice

Must be signed by the physicianMust be signed by the physicianMust state if transport assistance is required and Must state if transport assistance is required and

specify the type needed.specify the type needed.Must accompany the person and be in chart with Must accompany the person and be in chart with

signed copy of application.signed copy of application.

2626

Emergency AdmissionEmergency AdmissionTransportationTransportation

Transportation may be provided by:Transportation may be provided by:An applicant for a person’s emergency admission, An applicant for a person’s emergency admission, ororSpouse or guardian, Spouse or guardian, ororLaw enforcement officer, Law enforcement officer, ororHealth officerHealth officer

Federal EMTALA/COBRA governs transfer of persons Federal EMTALA/COBRA governs transfer of persons with emergency medical conditions (includes with emergency medical conditions (includes substance abuse and psychiatric emergencies) from substance abuse and psychiatric emergencies) from hospitals to other facilities.hospitals to other facilities.

2727

Emergency Medical ConditionsEmergency Medical Conditions

An An emergency medical conditionemergency medical condition means a means a medical condition manifesting itself by acute medical condition manifesting itself by acute symptoms of sufficient severity…such that the symptoms of sufficient severity…such that the absence of immediate medical attention could absence of immediate medical attention could reasonably be expected to result in any one of the reasonably be expected to result in any one of the following:following:  Serious jeopardy to patient healthSerious jeopardy to patient healthSerious impairment to bodily functionsSerious impairment to bodily functionsSerious dysfunction of any bodily organSerious dysfunction of any bodily organ

Psychiatric and substance abuse emergencies are Psychiatric and substance abuse emergencies are emergency medical conditions.emergency medical conditions.

2828

EMTALA /COBRAEMTALA /COBRA((Emergency Medical Treatment and Active Labor Act/Emergency Medical Treatment and Active Labor Act/

Consolidated Omnibus Budget Reconciliation Act)Consolidated Omnibus Budget Reconciliation Act)

COBRA / EMTALA takes precedence over state statutes when COBRA / EMTALA takes precedence over state statutes when in conflict in conflict 

All hospitals must comply (excludes CSUs, detox centers, All hospitals must comply (excludes CSUs, detox centers, ARFs, etc.)ARFs, etc.)

Appropriate transfer:Appropriate transfer:

1. Assess/stabilize for transfer.1. Assess/stabilize for transfer.

2. Consent of patient / representative or certification by 2. Consent of patient / representative or certification by physicianphysician

3. Full disclosure / clinical records3. Full disclosure / clinical records4. Prior approval by transfer destination4. Prior approval by transfer destination

5. Safe/a5. Safe/appropriate method of transferppropriate method of transfer

6. Transfer based on paying status6. Transfer based on paying status

2929

Emergency Admission DispositionEmergency Admission Disposition

Within 72 hours after emergency residential Within 72 hours after emergency residential admission, client must be assessed by attending admission, client must be assessed by attending doctor to determine need for further services (5 doctor to determine need for further services (5 days in OP).days in OP).

Based on assessment, a qualified professional* must:Based on assessment, a qualified professional* must: Release the client/referRelease the client/refer Retain the client voluntarilyRetain the client voluntarily Retain the client and file a petition for involuntary Retain the client and file a petition for involuntary

assessment or treatment (authorizes retention assessment or treatment (authorizes retention pending court order.pending court order.

3030

Alternative InvoluntaryAlternative InvoluntaryAssessment -- MinorsAssessment -- Minors

Admission to Juvenile Addiction Receiving Facility Admission to Juvenile Addiction Receiving Facility for minor meeting involuntary criteria upon for minor meeting involuntary criteria upon application from:application from:

– Parent, Parent, – Guardian, orGuardian, or– Legal custodianLegal custodian

Application must establish need for immediate Application must establish need for immediate admission and contain specific information, admission and contain specific information, including reasons why applicant believes criteria is including reasons why applicant believes criteria is met.met.

3131

Alternative InvoluntaryAlternative InvoluntaryAssessment -- MinorsAssessment -- Minors

Assessment by qualified professional within 72 Assessment by qualified professional within 72 hours to determine need for further services.hours to determine need for further services.

Physician can extend to total of 5 days if further Physician can extend to total of 5 days if further services are needed.services are needed.

Minor must be timely released or referred for Minor must be timely released or referred for further voluntary or involuntary treatment, further voluntary or involuntary treatment, whichever is most appropriate to minor’s needs.whichever is most appropriate to minor’s needs.

3232

Parental Participation in Minor’s Parental Participation in Minor’s TreatmentTreatment

A parent, legal guardian, or legal custodian A parent, legal guardian, or legal custodian who seeks involuntary admission of a minor who seeks involuntary admission of a minor to substance abuse treatment is required to to substance abuse treatment is required to participate in all aspects of treatment as participate in all aspects of treatment as determined appropriate by the director of determined appropriate by the director of the licensed service provider.the licensed service provider.

3333

Court InvolvedCourt Involved

InvoluntaryInvoluntary

Marchman Act ProvisionsMarchman Act Provisions

3434

Involuntary Assessment StabilizationInvoluntary Assessment StabilizationGeneral ProvisionsGeneral Provisions

Petitions filed with Clerk of Court in county Petitions filed with Clerk of Court in county where person is located.where person is located.

Circuit court has jurisdictionCircuit court has jurisdiction Chief judge may appoint general or special Chief judge may appoint general or special

master.master.

3535

Involuntary Assessment StabilizationInvoluntary Assessment StabilizationGeneral ProvisionsGeneral Provisions

Person has right to counsel Person has right to counsel at every stageat every stage of a petition for involuntary assessment or of a petition for involuntary assessment or treatment.treatment.

Court will appoint counsel if requested or if Court will appoint counsel if requested or if needed and person cannot afford to pay.needed and person cannot afford to pay.

Un-represented minor must have court-Un-represented minor must have court-appointed guardian ad litem.appointed guardian ad litem.

3636

Court Involved Involuntary Court Involved Involuntary Assessment/Stabilization Assessment/Stabilization PetitionPetition

AdultAdult: petition may be filed by:: petition may be filed by: Spouse, Spouse, Guardian, Guardian, Any relative, Any relative, Private practitioner, Private practitioner, Service provider director/designee, orService provider director/designee, or Any three adults having personal knowledge of Any three adults having personal knowledge of

person’s condition.person’s condition.

3737

Court Involved Involuntary Court Involved Involuntary Assessment/Stabilization Assessment/Stabilization PetitionPetition

MinorMinor: petition may be filed by:: petition may be filed by: parentparent legal guardianlegal guardian legal custodian, or legal custodian, or licensed service provider.licensed service provider.

3838

Provider Initiated PetitionsProvider Initiated Petitionsfor Involuntary Admissionsfor Involuntary Admissions

Providers may initiate petitions for:Providers may initiate petitions for:

involuntary assessment and stabilizationinvoluntary assessment and stabilization involuntary treatmentinvoluntary treatment

When that provider has direct knowledge of the When that provider has direct knowledge of the respondent's substance abuse impairment or when respondent's substance abuse impairment or when an extension of the involuntary admission period is an extension of the involuntary admission period is needed.needed.

3939

Provider Initiated PetitionsProvider Initiated Petitionsfor Involuntary Admissionsfor Involuntary Admissions

Providers must specify the:Providers must specify the:– Circumstances under which a petition will be Circumstances under which a petition will be

initiated and initiated and – Means by which petitions will be drafted, Means by which petitions will be drafted,

presented to the court, and monitored through presented to the court, and monitored through the process in conformance with federal and the process in conformance with federal and state confidentiality requirements.state confidentiality requirements.

Forms used and methods employed to ensure Forms used and methods employed to ensure adherence to legal timeframes must be included in adherence to legal timeframes must be included in

procedures.procedures.

4040

Court Involved Involuntary Court Involved Involuntary Assessment/StabilizationAssessment/Stabilization

Content of PetitionContent of Petition

Petition must contain:Petition must contain:

– Name of applicants and respondentName of applicants and respondent– Relationship between themRelationship between them– Name of attorney, if knownName of attorney, if known– Ability to afford an attorneyAbility to afford an attorney– Facts to support the need for involuntary Facts to support the need for involuntary

admission, including why petitioner believes admission, including why petitioner believes person meets each criteria for involuntary person meets each criteria for involuntary intervention.intervention.

4141

Court Involved Involuntary Court Involved Involuntary Assessment/Stabilization Assessment/Stabilization

Court DeterminationCourt Determination

Based on a hearing Based on a hearing oror solely on petition and solely on petition and without an attorney, enter an ex parte order without an attorney, enter an ex parte order authorizing assessment & stabilization. authorizing assessment & stabilization. If court determines that person meets criteria, If court determines that person meets criteria, he/she may be admitted: he/she may be admitted:

–Up to 5 days to hospital, detox or ARF for Up to 5 days to hospital, detox or ARF for assessment & stabilization, orassessment & stabilization, or–Less restrictive licensed setting for assessment Less restrictive licensed setting for assessment only.only.

4242

Court Involved Involuntary Court Involved Involuntary Assessment/Stabilization Assessment/Stabilization ProceduresProcedures

Upon receipt of petition and if a hearing is Upon receipt of petition and if a hearing is scheduled, a copy of petition & notice of hearing scheduled, a copy of petition & notice of hearing must be provided to:must be provided to:

–  Respondent, Respondent, –Attorney, Attorney, –Petitioner, Petitioner, –Spouse or guardian, Spouse or guardian, –Parent of a minor, and Parent of a minor, and –Others as directed by the courtOthers as directed by the court

4343

Involuntary Assessment/StabilizationInvoluntary Assessment/StabilizationProceduresProcedures

Summons issued to respondent and hearing Summons issued to respondent and hearing scheduled within 10 daysscheduled within 10 days

Court shall hear all relevant testimony at Court shall hear all relevant testimony at hearing.hearing.

Court may order law enforcement to transport to Court may order law enforcement to transport to nearest appropriate licensed service provider.nearest appropriate licensed service provider.

4444

Court Involved Involuntary Court Involved Involuntary Assessment/Stabilization Assessment/Stabilization HearingHearing

Court shall hear all relevant testimony at hearing.Court shall hear all relevant testimony at hearing.

Respondent must be present unless injurious and Respondent must be present unless injurious and guardian advocate is appointed.guardian advocate is appointed.

Right to examination by court-appointed qualified Right to examination by court-appointed qualified professional.professional.

Determination by court whether a reasonable Determination by court whether a reasonable basis to believe person meets involuntary basis to believe person meets involuntary admission criteria.admission criteria.

4545

Court Involved Involuntary Court Involved Involuntary Assessment/Stabilization Assessment/Stabilization HearingHearing

Court may either enter an order authorizing Court may either enter an order authorizing assessment & stabilization or dismiss petition.assessment & stabilization or dismiss petition.

Court may initiate Baker Act if condition is due to Court may initiate Baker Act if condition is due to mental illness other than or in addition to mental illness other than or in addition to substance abusesubstance abuse

Respondent or court may choose providerRespondent or court may choose provider

Order must include findings as to availability & Order must include findings as to availability & appropriateness of least restrictive alternatives & appropriateness of least restrictive alternatives & need for attorney to represent respondent.need for attorney to represent respondent.

4646

Involuntary AssessmentInvoluntary Assessment & Stabilization - Provider & Stabilization - Provider

Licensed provider may admit person for Licensed provider may admit person for assessment without delay, for a period of up to 5 assessment without delay, for a period of up to 5 days. days.

Provider may request court to extend time for Provider may request court to extend time for assessment & stabilization for 7 more days.assessment & stabilization for 7 more days.

Assessment must be reviewed by a physician.Assessment must be reviewed by a physician.

4747

Assessment StandardsAssessment Standardsfor Involuntary Treatmentfor Involuntary Treatment

Providers making assessments available to the court Providers making assessments available to the court regarding hearings for involuntary treatment must regarding hearings for involuntary treatment must define the process used to complete the assessment, define the process used to complete the assessment, including:including:

– Specifying the protocol to be utilized, Specifying the protocol to be utilized,

– Format and content of the report to the court, Format and content of the report to the court, and and

– Internal procedures used to ensure that Internal procedures used to ensure that assessments are completed and submitted within assessments are completed and submitted within legally specified timeframes. legally specified timeframes.

4848

Assessment StandardsAssessment Standardsfor Involuntary Treatmentfor Involuntary Treatment

For persons assessed under involuntary order, For persons assessed under involuntary order, provider shall address:provider shall address:

– Means by which the physician's review and Means by which the physician's review and signature for involuntary assessment and signature for involuntary assessment and stabilization will be secured; stabilization will be secured;

– Means by which the signature of a qualified Means by which the signature of a qualified professional for involuntary assessments only, will be professional for involuntary assessments only, will be secured. secured.

– Process used to notify affected parties stipulated in Process used to notify affected parties stipulated in the petition.the petition.

4949

Involuntary AssessmentInvoluntary Assessment & Stabilization- Disposition & Stabilization- Disposition

Based upon involuntary assessment, person may Based upon involuntary assessment, person may be:be:

ReleasedReleased Remain voluntarilyRemain voluntarily Retained if a petition for involuntary treatment Retained if a petition for involuntary treatment has been initiated.has been initiated.

Timely petition authorizes retention of client Timely petition authorizes retention of client pending further order of the court.pending further order of the court.

5050

Involuntary TreatmentInvoluntary TreatmentPetitionPetition

AdultsAdults: Petition may be filed by:: Petition may be filed by: SpouseSpouse Guardian Guardian Any relative Any relative Service provider, or Service provider, or Any 3 people having personal knowledge of Any 3 people having personal knowledge of

person’s impairment and prior course of person’s impairment and prior course of assessment and treatment. assessment and treatment.

Minors:Minors: Petition may be filed by: Petition may be filed by: A parentA parent Legal guardian, or Legal guardian, or Service provider.Service provider.

5151

Involuntary TreatmentInvoluntary TreatmentContents of PetitionContents of Petition

Name of respondentName of respondent Name of petitioner(s)Name of petitioner(s) Relationship between the respondent and petitionerRelationship between the respondent and petitioner Name of respondent’s attorneyName of respondent’s attorney Statement of petitioner’s knowledge of Statement of petitioner’s knowledge of

respondent’s ability to afford an attorneyrespondent’s ability to afford an attorney Findings & recommendations of the assessment Findings & recommendations of the assessment

performed by qualified professionalperformed by qualified professional Factual allegations presented by the petitioner Factual allegations presented by the petitioner

establishing need for involuntary treatment, establishing need for involuntary treatment, including:including:

5252

Involuntary TreatmentInvoluntary TreatmentContents of PetitionContents of Petition

Reason for petitioner’s belief that respondent is Reason for petitioner’s belief that respondent is substance abuse impaired; substance abuse impaired; andand

Reason for petitioner’s belief that because of such Reason for petitioner’s belief that because of such impairment, respondent has lost power of self-control impairment, respondent has lost power of self-control with respect to substance abuse; with respect to substance abuse; and eitherand either

a. Reason petitioner believes the respondent has a. Reason petitioner believes the respondent has inflicted or is likely to inflict physical harm on self/others inflicted or is likely to inflict physical harm on self/others unless admitted; unless admitted; oror

b. Reason petitioner believes respondent’s refusal to b. Reason petitioner believes respondent’s refusal to voluntarily receive care is based on judgment so voluntarily receive care is based on judgment so impaired by reason of substance abuse to be incapable impaired by reason of substance abuse to be incapable of appreciating need for care and making a rational of appreciating need for care and making a rational decision.decision.

5353

Involuntary Treatment Involuntary Treatment CriteriaCriteria

In addition to meeting the criteria for all In addition to meeting the criteria for all involuntary admissions, a person for whom a involuntary admissions, a person for whom a petition for involuntary placement is filed petition for involuntary placement is filed must have met additional conditions must have met additional conditions including:including:

Having been placed under Having been placed under protectiveprotective custody within the previous custody within the previous 10 days10 days;;

Having been subject to an Having been subject to an emergencyemergency admission within the previous admission within the previous 10 days10 days,,

5454

Involuntary Treatment Involuntary Treatment CriteriaCriteria

Having been assessed by a Having been assessed by a qualified qualified professionalprofessional within the previous within the previous 5 days5 days;;

Having been subject to a Having been subject to a court orderedcourt ordered involuntary assessment and stabilization involuntary assessment and stabilization within the previous within the previous 12 days12 days

Having been subject to Having been subject to alternative alternative involuntary admission within the previous involuntary admission within the previous 12 12 daysdays..

5555

Involuntary Treatment Involuntary Treatment Duties of CourtDuties of Court

Upon filing of petition with clerk of court, court shall Upon filing of petition with clerk of court, court shall immediately determine if respondent has attorney or immediately determine if respondent has attorney or if appointment of counsel is appropriateif appointment of counsel is appropriate

Court schedules hearing w/i 10 days.Court schedules hearing w/i 10 days. Copy of petition and notice of hearing provided to Copy of petition and notice of hearing provided to

respondent; attorney, spouse or guardian if respondent; attorney, spouse or guardian if applicable, petitioner, (parent, guardian or custodian applicable, petitioner, (parent, guardian or custodian of a minor), and other persons as the court may of a minor), and other persons as the court may direct; anddirect; and

Issue a summons to respondent.Issue a summons to respondent.

5656

Involuntary Treatment Involuntary Treatment HearingHearing

All relevant evidence, including results to all All relevant evidence, including results to all involuntary interventionsinvoluntary interventions

Client to be present unless injurious – if so, court Client to be present unless injurious – if so, court will appoint guardian advocatewill appoint guardian advocate

Petitioner has burden of proving by clear & Petitioner has burden of proving by clear & convincing evidence that all criteria for convincing evidence that all criteria for involuntary admission is metinvoluntary admission is met

Court will either dismiss petition or order client to Court will either dismiss petition or order client to involuntary treatment.involuntary treatment.

5757

Involuntary Treatment Involuntary Treatment OrderOrder

Order for involuntary treatment by licensed Order for involuntary treatment by licensed provider up to 60 daysprovider up to 60 days

Order authorizes provider to require client to Order authorizes provider to require client to undergo treatment that will benefit.undergo treatment that will benefit.

Order must include court’s requirement for Order must include court’s requirement for notification of proposed release.notification of proposed release.

Court may order Sheriff to transportCourt may order Sheriff to transport Court retains jurisdiction over case for further Court retains jurisdiction over case for further

orders.orders.

5858

Court Ordered Court Ordered Notification of ReleaseNotification of Release

When a court ordering involuntary treatment When a court ordering involuntary treatment includes requirement in court order for notification includes requirement in court order for notification of proposed release, provider must notify the of proposed release, provider must notify the original referral source in writing.original referral source in writing.

Notification shall comply with legally defined Notification shall comply with legally defined conditions and timeframes and conform to conditions and timeframes and conform to federal and statefederal and state confidentiality regulations. confidentiality regulations.

5959

Involuntary TreatmentInvoluntary TreatmentOrder – Order – Early ReleaseEarly Release

Client must be released when:Client must be released when:

Basis for involuntary treatment no longer existBasis for involuntary treatment no longer exist

Convert to voluntary upon informed consentConvert to voluntary upon informed consent

No longer in need of servicesNo longer in need of services

Client is beyond safe management of the providerClient is beyond safe management of the provider

Further treatment won’t bring about further Further treatment won’t bring about further significant improvementssignificant improvements

6060

Involuntary TreatmentInvoluntary TreatmentOrder – ExtensionOrder – Extension

When criteria still exists, a renewal of involuntary When criteria still exists, a renewal of involuntary treatment order may be requested at least treatment order may be requested at least 10 days 10 days priorprior to the end of the 60-day period. to the end of the 60-day period.

Hearing scheduled w/i 15 days of filingHearing scheduled w/i 15 days of filing Copy of petition to all partiesCopy of petition to all parties If grounds exist, may be ordered for up to If grounds exist, may be ordered for up to 90 90

additional daysadditional days.. Further petitions for 90 day periods may be filed if Further petitions for 90 day periods may be filed if

grounds for involuntary treatment persist.grounds for involuntary treatment persist.

6161

ReleaseRelease from Involuntary Status from Involuntary Status

After 60-day involuntary treatment, client After 60-day involuntary treatment, client automatically discharged unless petition timely filed automatically discharged unless petition timely filed with court.with court.

Person may be released by a qualified professional, Person may be released by a qualified professional, without court order.without court order.

Notice of release provided to applicant for a minor or Notice of release provided to applicant for a minor or to petitioner and court if court-ordered.to petitioner and court if court-ordered.

Release of minor must be to parent or guardian, DCF Release of minor must be to parent or guardian, DCF or DJJ.or DJJ.

6262

Transfer from Transfer from Involuntary to Voluntary StatusInvoluntary to Voluntary Status

An involuntarily admitted clientAn involuntarily admitted client may may, ,

upon giving upon giving written informed consentwritten informed consent, ,

be be referredreferred to a service provider to a service provider forfor voluntaryvoluntary admission admission

when the provider determines that the client when the provider determines that the client no no longer meets involuntary criterialonger meets involuntary criteria..

6363

Habitual AbusersHabitual Abusers

No political subdivision may adopt a local No political subdivision may adopt a local ordinance making ordinance making impairment in publicimpairment in public in and of in and of itself an offense. Local ordinances for the itself an offense. Local ordinances for the treatment of habitual abusers must provide: treatment of habitual abusers must provide:

For the construction and funding, of a licensed For the construction and funding, of a licensed securesecure facility facility to be used exclusively for the to be used exclusively for the treatment of habitual abuserstreatment of habitual abusers who meet the who meet the criteria. criteria.

6464

Habitual AbusersHabitual Abusers

When seeking treatment of a habitual abuser, the When seeking treatment of a habitual abuser, the county or municipality, through an officer or agent county or municipality, through an officer or agent specified in the ordinance, must file with the court a specified in the ordinance, must file with the court a petition which alleges specified information about petition which alleges specified information about the alleged habitual abuser:the alleged habitual abuser:Person can be held up to 96 hours in a secure Person can be held up to 96 hours in a secure facility while a petition is prepared and filed.facility while a petition is prepared and filed.Attorney to be appointedAttorney to be appointedHearing conducted within 10 days.Hearing conducted within 10 days.May be ordered up to 90 days in treatmentMay be ordered up to 90 days in treatmentExtensions of up to 180 days can be requested.Extensions of up to 180 days can be requested.

6565

Offender ReferralsOffender ReferralsTreatment-Based CourtsTreatment-Based Courts

If any offender, including a minor, is charged If any offender, including a minor, is charged with or convicted of a crime, the court may with or convicted of a crime, the court may require the offender to receive services require the offender to receive services from a licensed service provider. If referred from a licensed service provider. If referred by the court, the referral shall be in addition by the court, the referral shall be in addition to final adjudication, imposition of penalty to final adjudication, imposition of penalty or sentence, or other action. or sentence, or other action.

6666

Offender ReferralsOffender ReferralsTreatment-Based CourtsTreatment-Based Courts

The order must specify:The order must specify:  The name of the offender, The name of the offender, TThe name and address of the service he name and address of the service provider to which the offender is referred,provider to which the offender is referred,

The date of the referral, The date of the referral, The duration of the offender's sentence, The duration of the offender's sentence, and and

All conditions stipulated by the referral All conditions stipulated by the referral source. source.

6767

Offender Referrals Offender Referrals Treatment-Based CourtsTreatment-Based Courts

The total amount of time the offender The total amount of time the offender is required to receive treatment may is required to receive treatment may not exceed the maximum length of not exceed the maximum length of sentence possible for the offense with sentence possible for the offense with which the offender is charged or which the offender is charged or convicted. convicted.

  

6868

Offender ReferralsOffender ReferralsTreatment-Based CourtsTreatment-Based Courts

The director may refuse to admit any offender The director may refuse to admit any offender referred to the service provider, with the reason referred to the service provider, with the reason communicated immediately and in writing within communicated immediately and in writing within 72 hours to the referral source 72 hours to the referral source

The director may discharge any offender referred The director may discharge any offender referred when, in the judgment of the director, the offender when, in the judgment of the director, the offender is beyond the safe management capabilities of the is beyond the safe management capabilities of the service provider. service provider.

When an offender successfully completes When an offender successfully completes treatment or when the time period during which treatment or when the time period during which the offender is required to receive treatment the offender is required to receive treatment expires, the director shall communicate such fact expires, the director shall communicate such fact to the referral source.to the referral source.

6969

Inmate Substance Abuse ProgramsInmate Substance Abuse Programs

Inmate Substance Abuse ProgramsInmate Substance Abuse Programs are are provided within facilities housing only inmates and provided within facilities housing only inmates and operated by or under contract with the Department operated by or under contract with the Department of Corrections.of Corrections.

InmateInmate means any person committed by a court of means any person committed by a court of competent jurisdiction to the custody of DOC, competent jurisdiction to the custody of DOC, including transfers from federal and state agencies.including transfers from federal and state agencies.

Inmate substance abuse servicesInmate substance abuse services means any means any service provided directly by the DOC and licensed & service provided directly by the DOC and licensed & regulated by DCF or provided through contract with regulated by DCF or provided through contract with a licensed service provider; or any self-help a licensed service provider; or any self-help program or volunteer support group operating for program or volunteer support group operating for inmates. inmates.

7070

Client RightsClient Rights Individual DignityIndividual Dignity Non-discriminatory ServicesNon-discriminatory Services Quality ServicesQuality Services CommunicationCommunication Care & Custody of Personal EffectsCare & Custody of Personal Effects Education of MinorsEducation of Minors ConfidentialityConfidentiality CounselCounsel Habeas CorpusHabeas Corpus

7171

Individual DignityIndividual Dignity

Respect at all times, including when Respect at all times, including when admitted retained, or transported. admitted retained, or transported.

Cannot be placed in jail unless accused of Cannot be placed in jail unless accused of a crime a crime exceptexcept for protective custody. for protective custody.

Guaranteed all constitutional rightsGuaranteed all constitutional rights

7272

Quality ServicesQuality Services

Least restrictive and most appropriate services, Least restrictive and most appropriate services, based on needs & best interests of client.based on needs & best interests of client.

Services suited to client’s needs, administered Services suited to client’s needs, administered skillfully, safely, humanely, with full respect for skillfully, safely, humanely, with full respect for dignity/integrity, and in compliance with all laws dignity/integrity, and in compliance with all laws and requirements.and requirements.

Methods used to control aggressive client behavior Methods used to control aggressive client behavior that pose an immediate threat to the client or that pose an immediate threat to the client or others – used by staff trained & authorized to do so others – used by staff trained & authorized to do so – in accordance with rule.– in accordance with rule.

Opportunity to participate in formulation/review of Opportunity to participate in formulation/review of individualized treatment / service plan.individualized treatment / service plan.

7373

CommunicationCommunication

Free & private communication within limits Free & private communication within limits imposed by provider.imposed by provider.

Close supervision of all communication & Close supervision of all communication & correspondence required.correspondence required.

Reasonable rules for mail, telephone & Reasonable rules for mail, telephone & visitation to ensure the well-being of visitation to ensure the well-being of clients, staff & community.clients, staff & community.

7474

Care & Custody of Personal EffectsCare & Custody of Personal Effects

Right to possess clothing and other personal Right to possess clothing and other personal effects.effects.

Provider may take temporary custody of personal Provider may take temporary custody of personal effects only when required for medical or safety effects only when required for medical or safety reasons.reasons.

If removed, reasons for taking custody and a list If removed, reasons for taking custody and a list of the personal effects must be recorded in of the personal effects must be recorded in clinical record.clinical record.

7575

Right to CounselRight to Counsel

Client must be informed of right to counsel at Client must be informed of right to counsel at every stage of involuntary proceedings.every stage of involuntary proceedings.

May be represented by counsel in any involuntary May be represented by counsel in any involuntary proceeding for assessment, stabilization, or proceeding for assessment, stabilization, or treatment that person (or guardian of a minor)treatment that person (or guardian of a minor)

Apply to court to have attorney appointed if Apply to court to have attorney appointed if unable to afford one.unable to afford one.

7676

Habeas CorpusHabeas Corpus Filed at any time and without noticeFiled at any time and without notice

Filed by client involuntarily retained or parent, Filed by client involuntarily retained or parent, guardian, custodian, or attorney on behalf of guardian, custodian, or attorney on behalf of clientclient

May petition for writ to question cause and May petition for writ to question cause and legality of retention and request the court to legality of retention and request the court to issue a writ for client’s releaseissue a writ for client’s release

7777

ConfidentialityConfidentiality

Identity, diagnosis, prognosis, and service Identity, diagnosis, prognosis, and service provision to any client is confidential. provision to any client is confidential. Response to requests for information can’t Response to requests for information can’t reveal that person was ever a client.reveal that person was ever a client.

7878

ConfidentialityConfidentiality

Disclosure requires written consent of client, except:Disclosure requires written consent of client, except:

Medical personnel in emergencyMedical personnel in emergency Provider staff on “need to know” to carry out duties to Provider staff on “need to know” to carry out duties to

client.client. DCF Secretary/designee for research (non-identifying)DCF Secretary/designee for research (non-identifying) Audit or evaluation by federal, state, local Audit or evaluation by federal, state, local

governments, or 3governments, or 3rdrd party payor party payor Court order for good cause based on whether public Court order for good cause based on whether public

interest/need for disclosure outweigh potential injury interest/need for disclosure outweigh potential injury to client or provider to to client or provider to authorizeauthorize disclosure but disclosure but subpoenasubpoena then required to then required to compel.compel.

7979

ConfidentialityConfidentiality

Restrictions inapplicable to reporting of suspected Restrictions inapplicable to reporting of suspected child abuse. child abuse.

Minor may consent to own disclosure – consent Minor may consent to own disclosure – consent can only be given by the minorcan only be given by the minor

If consent of guardian required to obtain services If consent of guardian required to obtain services for minor, both minor & guardian must consent to for minor, both minor & guardian must consent to disclosuredisclosure

Federal Regulations and HIPAA also control how Federal Regulations and HIPAA also control how information can be released – most stringent information can be released – most stringent prevails.prevails.

8080

Confidentiality & the CourtsConfidentiality & the Courts

Court order authorizes but does not compel Court order authorizes but does not compel disclosure of client identifying data.disclosure of client identifying data.

Subpoena must then be issued to compel disclosure.Subpoena must then be issued to compel disclosure.

Client and provider must be given notice and Client and provider must be given notice and opportunity to respond or to appear to provide opportunity to respond or to appear to provide evidence.evidence.

Oral argument, review of evidence or hearing in Oral argument, review of evidence or hearing in chambers.chambers.

8181

Confidentiality & the CourtsConfidentiality & the Courts

Court may authorize release for criminal investigation Court may authorize release for criminal investigation or prosecution only if all the following are met:or prosecution only if all the following are met:

Extremely serious crimeExtremely serious crime Likelihood records will be of substantial valueLikelihood records will be of substantial value Other ways of obtaining information not available or Other ways of obtaining information not available or

effective.effective. Potential injury to client & provider is outweighed by Potential injury to client & provider is outweighed by

public interest and need for disclosurepublic interest and need for disclosure..

8282

Confidentiality & Law EnforcementConfidentiality & Law Enforcement

Provider can release when related to client’s Provider can release when related to client’s commission of a crime on premises of the commission of a crime on premises of the provider or against provider personnel or to a provider or against provider personnel or to a threat to commit such crime.threat to commit such crime.

Limited to circumstances of the incident, Limited to circumstances of the incident, including client status, client name/address & including client status, client name/address & client’s last known whereabouts.client’s last known whereabouts.

8383

Unlawful ActivitiesUnlawful Activities

Service provider personnel who Service provider personnel who violate or abuse any right or privilege violate or abuse any right or privilege of a client are liable for damages as of a client are liable for damages as determined by law.determined by law.

Knowingly furnishing false information Knowingly furnishing false information to obtain involuntary admissionto obtain involuntary admission

8484

Unlawful ActivitiesUnlawful Activities

Causing, securing or conspiring to Causing, securing or conspiring to secure involuntary proceduressecure involuntary procedures

Causing or conspiring or assisting Causing or conspiring or assisting another to deny a person rightsanother to deny a person rights

All misdemeanor of 1All misdemeanor of 1stst degree, degree, punishable as provided in s.775.082 punishable as provided in s.775.082 and up to $5,000.and up to $5,000.

8585

ImmunityImmunity A law enforcement officer acting in A law enforcement officer acting in

good faith pursuant to the Marchman good faith pursuant to the Marchman Act may not be held criminally or Act may not be held criminally or civilly liable for false imprisonment.civilly liable for false imprisonment.

8686

ImmunityImmunity

All persons acting in good faith, reasonably, All persons acting in good faith, reasonably, and and without negligencewithout negligence in connection with in connection with the preparation of petitions, applications, the preparation of petitions, applications, certificates, or other documents or the certificates, or other documents or the apprehension, detention, discharge, apprehension, detention, discharge, examination, transportation or treatment examination, transportation or treatment under the Marchman Act shall be free from under the Marchman Act shall be free from all liability, civil or criminal, by reason of all liability, civil or criminal, by reason of such acts.such acts.