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placed on a Baker Act? Is there a statute to this effect and if so what is it? Concerning the possibility of the Transportation Exception Plan, what are the steps involved/time frames to get this? Is there criteria that must be met in order to qualify for this? Do you know of facilities that have a Transportation Exception Plan in effect, and if so, how does it work for them?

Enclosed information below that describes the statutory and code requirements related to Transportation Exception Plans.

394.462 Transportation.--

(1) Transportation to a Receiving Facility.--

(a) Each county shall designate a single law enforcement agency within the county, or portions thereof, to take a person into custody upon the entry of an ex parte order or the execution of a certificate for involuntary examination by an authorized professional and to transport that person to the nearest receiving facility for examination. The designated law enforcement agency may decline to transport the person to a receiving facility only if: (a number of exceptions are listed in the law)

(3) EXCEPTIONS.--An exception to the requirements of this section may be granted by the secretary of the department for the purposes of improving service coordination or better meeting the special needs of individuals. A proposal for an exception must be submitted by the district administrator after being approved by the governing boards of any affected counties, prior to submission to the secretary.

(a) A proposal for an exception must identify the specific provision from which an exception is requested; describe how the proposal will be implemented by participating law enforcement agencies and transportation authorities; and provide a plan for the coordination of services such as case management. (b) The exception may be granted only for:

1. An arrangement centralizing and improving the provision of services within a district, which may include an exception to the requirement for transportation to the nearest receiving facility;

2. An arrangement by which a facility may provide, in addition to required psychiatric services, an environment and services which are uniquely tailored to the needs of an identified group of persons with special needs, such as persons with hearing impairments or visual impairments, or elderly persons with physical frailties; or

3. A specialized transportation system that provides an efficient and humane method of transporting patients to receiving facilities, among receiving facilities, and to treatment facilities.

(c) Any exception approved pursuant to this subsection shall be reviewed and approved every 5 years by the secretary.

65E-5.2601 Transportation Exception Plan.

(1) In determining whether to approve a proposal for an exception or exceptions to the transportation requirements of Section 394.462(3), F.S., the following shall be considered by the department:

(a) The specific provision from which an exception is requested;

(b) Evidence presented by the department’s district or region of community need and support for the request;

(c) Whether the proposal is presented in a format that is clear, simple, and can be readily implemented by all parties and the public;

(d) How the proposed plan will improve services to the public and persons needing Baker Act services; and

(e) Whether the geographic boundaries identified in the proposal are distinct and unambiguous.

(2) The proposal must include provisions which address:

(a) Accountability for delays or confusion when transportation fails to respond appropriately;

(b) How disputes which may arise over implementation of the plan will be resolved; (c) Identification of the public official whose position is responsible for the continuing

oversight and monitoring of the service in compliance with the terms of the approved proposal;

(d) The plan for periodically monitoring compliance with the proposal, public satisfaction with the service provided, and assurance of rights of each person served by the facility;

(e) The method complaints and grievances are to be received and resolved; and (f) Community support and involvement including a description of the participation of

designated public and private receiving facilities, law enforcement, transportation officials, consumers, families, and advocacy groups.

(3) The approval by the governing boards of any affected counties, shall be certified in writing by the district or region’s mental health and substance abuse program supervisor, prior to the plan’s submission to the Secretary of the Department.

Under the federal EMTALA law, your hospital is required to accept all persons and to perform a medical screening examination, regardless of age or type of condition. This applies to those on voluntary or involuntary status. An emergency psychiatric condition is considered by the federal government to be an emergency medical condition even if no other medical condition exists. If you had no beds for psychiatrically impaired minors,

your hospital would be responsible for seeking out a specialty hospital or receiving facility and obtaining prior approval before transferring the child once stabilized for transfer. You would be responsible for arranging safe and appropriate transport for the child to the destination facility.

EMTALA, the Emergency Medical Treatment and Active Labor Act, is the patient

“antidumping” provision of Section 1867 of the Social Security Act. Corresponding state statutes are included in Chapter 395.1041 governing Access to Emergency Care. Chapter 395 is Florida’s hospital licensing statute. It is more stringent than the federal EMTALA law in places.

With regard to your questions about hospitals’ obligations under the Baker Act, chapter 395 addresses this in several cites.

395.003(5)(a) governing licensure of all hospitals states “Adherence to patient rights, standards of care, and examination and placement procedures provided under part I of chapter 394 shall be a condition of licensure for hospitals

providing voluntary or involuntary medical or psychiatric observation, evaluation, diagnosis, or treatment”.

(5)(b)”Any hospital that provides psychiatric treatment to persons under 18 years of age who have emotional disturbances shall comply with the procedures pertaining to the rights of patients prescribed in part I of chapter 394”.

395.1041(6) RIGHTS OF PERSONS BEING TREATED.--A hospital providing emergency services and care to a person who is being involuntarily examined under the provisions of s. 394.463 shall adhere to the rights of patients specified in part I of chapter 394 and the involuntary examination procedures provided in s. 394.463, regardless of whether the hospital, or any part thereof, is designated as a receiving or treatment facility under part I of chapter 394 and regardless of whether the person is admitted to the hospital.

395.1055(5) governing rules and enforcement states “The agency shall enforce the provisions of part I of chapter 394, and rules adopted thereunder, with respect to the rights, standards of care, and examination and placement

procedures applicable to patients voluntarily or involuntarily admitted to hospitals providing psychiatric observation, evaluation, diagnosis, or treatment”.

395.1065(6) governing criminal and administrative penalties states “In seeking to impose penalties against a facility as defined in s. 394.455 for a violation of part I of chapter 394, the agency is authorized to rely on the investigation and findings by the Department of Health in lieu of conducting its own investigation”.

It appears from your message that your hospital may intend to retain its adult psychiatric unit and its designation as a receiving facility? If so, even under the state’s Baker Act it would required to accept any person brought by law enforcement for involuntary

examination. A Transportation Exception Plan could be submitted to your Board of County Commissioners and to the DCF Secretary for approval to have minors of the age you specify diverted away from your hospital unless they have significant medical

Q. We have an adolescent who will be going to a residential program where a