Marchman Act

1. Marchman Act The Florida Substance Abuse Impairment Act

2. History of theMarchman Act • Myers Act (396, FS) • Drug Dependency Act (397, FS) • Hal S. Marchman Alcohol & Other Drug Services Act of 1993 -- addresses the entire array of substance abuse impairment issues. • Not just the substance abuse version of the Baker Act!!

3. Legislative Intent Substance Abuse is a major health problem leading to: • Serious impairment • Chronic addiction • Criminal behavior • Vehicular casualties • Spiraling health care costs • HIV/AIDS • Business losses • Children’s learning ability • Family dysfunction

4. Substance AbuseDefined Substance Abuse means: • Use of any substance if such use is unlawful or • if such use is detrimental to the user or to others, but is not unlawful.

5. Substance Abuse Impairment Defined A condition involving the use of alcohol or any psychoactive or mood-altering substance in such a manner as to induce: • mental, • emotional, or • physical problems And cause socially dysfunctional behavior

6. Service ProvidersDefined • Public agencies, • Private for-profit or not-for-profit agencies, • Specified private practitioners, and • Hospitals • that are DCF licensed or exempt from licensure under the Marchman Act.

7. Service Definitions • Hospital – Licensed by AHCA under chapter 395, FS • Detox Center – uses medical and psychological procedures and supportive counseling to manage toxicity and withdrawing/stabilizing from effects of substance abuse. • Addiction Receiving Facility (ARF) –state contracted and designated secure facility providing intensive level of care capable of handling aggressive behavior/deter elopements for persons meeting involuntary assessment/treatment

8. Admission Types I. Voluntary Admissions II. Involuntary Admissions: Non-Court Involved: • Protective Custody • Emergency • Alternative Involuntary Assessment for minors Court Involved: • Involuntary Assessment/Stabilization • Involuntary Treatment

9. All AdmissionsProvider Responsibilities Any person, including minors, may apply for voluntary admission. Person must be admitted when sufficient evidence exists that: • Person is SA impaired • Setting Is the least restrictive and appropriate • Within licensed census • Medical & behavioral condition can be safely managed • Within financial means of person

10. Provider Responsibilities(continued) • Persons involuntarily placed only in licensed service providers in components authorized to accept involuntary clients. • Providers accepting person on involuntary statusmust provide a description of the eligibility and diagnostic criteria and the placement process to be followed for each of the involuntary placement procedures • decision to refuse to admit or to discharge shall be made only by a qualified professional.

11. Non-Discriminatory Services • Access cannot be denied based on race, gender, ethnicity, age, sexual preference, HIV status, disability, use of prescribed medications, prior service departures against medical advice, or number of relapse episodes. • Publicly funded providers cannot deny access to services based solely on inability to pay , if space and state resources are available.

12. Non-AdmissionProvider Responsibilities • If not admitted & consistent with federal confidentiality, must attempt contact with the referral source to discuss the circumstances and assist in arranging for alternative interventions. • If unable to reach referral source, provider must refuse admission and attempt to assist person in gaining access to other appropriate services. • Report within 1 workday in writing to referral source, the basis of refusal and efforts made to contact referral source and assist person.

13. Client Responsibility for Cost of Services • Must have a fee system based upon a client’s ability to pay, and if space and sufficient state resources are available, may not deny a client access to services solely on the basis of client’s inability to pay. • Full charge & fee charged must be disclosed to client • Client (or guardian of minor) required to contribute toward costs, based on ability to pay • Guardian of minor not liable if services provided without parent consent unless guardian ordered to pay

14. Involuntary AdmissionsCriteria • Good faith reason to believe person is substance abuse impaired and because of the impairment: • Has lost power of self-control over substance use; and either:

15. Involuntary Admission Criteria (continued) • Has inflicted, or threatened or attempted to inflict, or unless admitted is likely to inflict, physical harm on self or others, or • Is in need of substance abuse services and, by reason of substance abuse impairment, his/her judgment has been so impaired the person is incapable of appreciating the need for services and of making a rational decision in regard thereto. (Mere refusal to receive services not evidence of lack of judgment)

16. Non-Court Involved Admissions • Protective Custody • Emergency • Alternative Involuntary Assessment for Minors

17. Protective Custody • Law enforcement may implement for adults or minors when involuntary admission criteria appears to be met. • Who is in a public place or is brought to attention of LEO. • Person may consent to LEO assistance to home, hospital, licensed detox center, or addictions receiving facility, whichever the LEO determines is most appropriate.

18. Protective CustodyWithout Consent Law enforcement officer may take person to: • hospital, • detox, or • ARF, or An adult may be taken to jail. Not an arrest and no record made.

19. Jail Responsibility • Jail must notify nearest appropriate licensed provider within 8 hours and shall arrange transport to provider with an available bed. • Must be assessed by jail’s attending physician without unnecessary delay but within 72-hours

20. Protective Custody Must be released by a qualified professional* when: • Client no longer meets the involuntary admission criteria, or • The 72-hour period has elapsed; or • Client has consented to remain voluntarily, or • Petition for involuntary assessment or treatment has been initiated. Timely filing of petition authorizes retention of client pending further order of the court.

21. Qualified Professional Defined • Physician licensed under 458 or 459; • Professional licensed under chapter 490 or 491 (Psychologist, Clinical SW, Marriage & Family Therapist or Mental Health Counselor); or • Person who is certified through a DCF recognized certification process for substance abuse treatment services and who holds, at a minimum, a bachelor’s degree. • Reciprocity with other states – meet Florida requirements within 1 year. • Grandfather – certified in Florida prior to 1/1/95.

22. Emergency Admissions A person meeting involuntary admission criteria may be admitted to: • A hospital, • A licensed detox, or • An ARF for emergency assessment and stabilization upon receipt of a physician’scertificate and completion of an application.

23. Emergency AdmissionInitiation An application for emergency admission may be initiated: For a minor by the parent, guardian or legal custodian. For adults: • Certifying physician • Spouse or guardian • Any relative • Any other responsible adult who has personal knowledge of the person’s substance abuse impairment.

24. Physician’s Certificate Physician’s Certificate must include: • Name of client • Relationship between client and physician • Relationship between physician and provider • Statement that exam & assessment occurred within 5 days of application date, and

25. Physician’s Certificate(Continued) Factual allegations about the need for emergency admission: • Reasons for physician’s belief the person meets each criteria for involuntary admission • Must recommend the least restrictive type of service • Must be signed by the physician • Must state if transport assistance is required and specify the type needed. • Must accompany the person and be in chart with signed copy of application.

26. Emergency AdmissionTransportation Transportation may be provided by: • An applicant for a person’s emergency admission, or • Spouse or guardian, or • Law enforcement officer, or • Health officer Federal EMTALA/COBRA governs transfer of persons with emergency medical conditions (includes substance abuse and psychiatric emergencies) from hospitals to other facilities.

27. Emergency Medical Conditions An emergency medical condition means a medical condition manifesting itself by acute symptoms of sufficient severity…such that the absence of immediate medical attention could reasonably be expected to result in any one of the following: • Serious jeopardy to patient health • Serious impairment to bodily functions • Serious dysfunction of any bodily organ Psychiatric and substance abuse emergencies are emergency medical conditions.

28. EMTALA /COBRA(Emergency Medical Treatment and Active Labor Act/Consolidated Omnibus Budget Reconciliation Act) • COBRA / EMTALA takes precedence over state statutes when in conflict  • All hospitals must comply (excludes CSUs, detox centers, ARFs, etc.) • Appropriate transfer: 1. Assess/stabilize for transfer. 2. Consent of patient / representative or certification by physician 3. Full disclosure / clinical records4. Prior approval by transfer destination 5. Safe/appropriate method of transfer6. Transfer based on paying status

29. Emergency Admission Disposition Within 72 hours after emergency residential admission, client must be assessed by attending doctor to determine need for further services (5 days in OP). Based on assessment, a qualified professional* must: • Release the client/refer • Retain the client voluntarily • Retain the client and file a petition for involuntary assessment or treatment (authorizes retention pending court order.

30. Alternative InvoluntaryAssessment -- Minors Admission to Juvenile Addiction Receiving Facility for minor meeting involuntary criteria upon application from: • Parent, • Guardian, or • Legal custodian Application must establish need for immediate admission and contain specific information, including reasons why applicant believes criteria is met.

31. Alternative InvoluntaryAssessment -- Minors • Assessment by qualified professional within 72 hours to determine need for further services. • Physician can extend to total of 5 days if further services are needed. • Minor must be timely released or referred for further voluntary or involuntary treatment, whichever is most appropriate to minor’s needs.

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

33. Court Involved Involuntary Marchman Act Provisions

34. Involuntary Assessment StabilizationGeneral Provisions • Petitions filed with Clerk of Court in county where person is located. • Circuit court has jurisdiction • Chief judge may appoint general or special master. • Person has right to counsel at every stage of a petition for involuntary assessment or treatment. • Court will appoint counsel if requested or if needed and person cannot afford to pay. • Un-represented minor must have court-appointed guardian ad litem.

35. Court Involved Involuntary Assessment/StabilizationPetition Adult: petition may be filed by: • Spouse, • Guardian, • Any relative, • Private practitioner, • Service provider director/designee, or • Any three adults having personal knowledge of person’s condition. Minor: petition may be filed by: • parent • legal guardian • legal custodian, or • licensed service provider.

36. Provider Initiated Petitionsfor Involuntary Admissions Providers may initiate petitions for: • involuntary assessment and stabilization • involuntary treatment When that provider has direct knowledge of the respondent's substance abuse impairment or when an extension of the involuntary admission period is needed.

37. Provider Initiated Petitionsfor Involuntary Admissions(continued) Providers must specify the: • Circumstances under which a petition will be initiated and • Means by which petitions will be drafted, presented to the court, and monitored through the process in conformance with federal and state confidentiality requirements. Forms used and methods employed to ensure adherence to legal timeframes must be included in procedures.

38. Court Involved Involuntary Assessment/StabilizationContent of Petition Petition must contain: • Name of applicants and respondent • Relationship between them • Name of attorney, if known • Ability to afford an attorney • Facts to support the need for involuntary admission, including why petitioner believes person meets each criteria for involuntary intervention.

39. Court Involved Involuntary Assessment/StabilizationCourt Determination Based on a hearing or solely on petition and without an attorney, enter an ex parte order authorizing assessment & stabilization. If court determines that person meets criteria, he/she may be admitted: • Up to 5 days to hospital, detox or ARF for assessment & stabilization, or • Less restrictive licensed setting for assessment only

40. Court Involved Involuntary Assessment/StabilizationProcedures Upon receipt of petition and if a hearing is scheduled, a copy of petition & notice of hearing must be provided to: • Respondent, • Attorney, • Petitioner, • Spouse or guardian, • Parent of a minor, and • Others as directed by the court

41. Involuntary Assessment/StabilizationProcedures(continued) • Summons issued to respondent and hearing scheduled within 10 days • Court shall hear all relevant testimony at hearing. • Court may order law enforcement to transport to nearest appropriate licensed service provider.

42. Court Involved Involuntary Assessment/StabilizationHearing • Court shall hear all relevant testimony at hearing. • Respondent must be present unless injurious and guardian advocate is appointed. • Right to examination by court-appointed qualified professional. • Determination by court whether a reasonable basis to believe person meets involuntary admission criteria.

43. Court Involved Involuntary Assessment/StabilizationHearing (continued) • Court may either enter an order authorizing assessment & stabilization or dismiss petition. • Court may initiate Baker Act if condition is due to mental illness other than or in addition to substance abuse • Respondent or court may choose provider • Order must include findings as to availability & appropriateness of least restrictive alternatives & need for attorney to represent respondent.

44. Involuntary Assessment & Stabilization - Provider • Licensed provider may admit person for assessment without delay, for a period of up to 5 days. • Provider may request court to extend time for assessment & stabilization for 7 more days. • Assessment must be reviewed by a physician.

45. Assessment Standardsfor Involuntary Treatment Providers making assessments available to the court regarding hearings for involuntary treatment must define the process used to complete the assessment, including : • Specifying the protocol to be utilized, • Format and content of the report to the court, and • Internal procedures used to ensure that assessments are completed and submitted within legally specified timeframes.

46. Assessment Standardsfor Involuntary Treatment(continued) For persons assessed under involuntary order, provider shall address: • Means by which the physician's review and signature for involuntary assessment and stabilization will be secured; • Means by which the signature of a qualified professional for involuntary assessments only, will be secured. • Process used to notify affected parties stipulated in the petition.

47. Involuntary Assessment & Stabilization-Disposition Based upon involuntary assessment, person may be: • Released • Remain voluntarily • Retained if a petition for involuntary treatment has been initiated. Timely petition authorizes retention of client pending further order of the court.

48. Involuntary TreatmentPetition Adults: Petition may be filed by: • Spouse • Guardian • Any relative • Service provider, or • Any 3 people having personal knowledge of person’s impairment and prior course of assessment and treatment. Minors: Petition may be filed by: • A parent • Legal guardian, or • Service provider.

49. Involuntary TreatmentContents of Petition • Name of respondent • Name of petitioner(s) • Relationship between the respondent and petitioner • Name of respondent’s attorney • Statement of petitioner’s knowledge of respondent’s ability to afford an attorney • Findings & recommendations of the assessment performed by qualified professional • Factual allegations presented by the petitioner establishing need for involuntary treatment, including:

50. Involuntary TreatmentContents of Petition (continued) Reason for petitioner’s belief that respondent is substance abuse impaired; and Reason for petitioner’s belief that because of such impairment, respondent has lost power of self-control with respect to substance abuse; and either a. Reason petitioner believes the respondent has inflicted or is likely to inflict physical harm on self/others unless admitted; or b. Reason petitioner believes respondent’s refusal to voluntarily receive care is based on judgment so impaired by reason of substance abuse to be incapable of appreciating need for care and making a rational decision.