HOSPITAL AND ADDICTION CENTER
HANDBOOK
Revised 1/24/14
NOTICE OF HEALTH INFORMATION PRACTICES
This notice describes how medical information about you may be used and disclosed and how you can get access to this
information. Please review it carefully.
Understanding Your Health Record/Information
Each time you visit a hospital, physician or other healthcare provider, a record of your visit is made. Typically, the record contains
your symptoms, examination and test results, diagnoses, treatment and a plan for future care or treatment. This information often
is referred as your health or medical record, and serves as a:
Basis for planning your care and treatment; means of communication among the many health care
professionals who contribute to your care; legal document describing the care you received; means by
which you or a third-party payer can verify that services billed were actually provided; a tool in educating
health care professionals; a source of data for medical research; a source of information for public health
officials charged with improving the health of the nation; a source of data for facility planning and
marketing; a tool with which we can assess and continually work to improve the care we render and the
outcomes we achieve.
Understanding what is in your record and how your health information is used helps you to: ensure its accuracy; better understand
who, what, when, where and why others may access your health information; make more informed decisions when authorizing
disclosure to others. Examples of disclosures: for treatment, payment, and healthcare operations.
Your Health Information Rights
Although your health record is the physical property of the healthcare practitioner or facility that compiled it, the information
belongs to you. You have the right to:
Request restrictions on certain uses and disclosures of your information as provided by 45 CFR 164.522;
(HIPAA) obtain a paper copy of the notice of information practices upon request; inspect and copy our
health record as provided for in 45 CFR 164.524 and applicable Florida Statutes; amend your health
record as provided in 45 CFR 164.528, request communication of your health information by alternative
means or at alternative locations; revoke your authorizations to use or disclose health information except
to the extent the action has already been taken.
This Organization is required to:
Maintain the privacy of your health information; provide you with a notice as to our legal duties and
privacy practices with respect to information we collect and maintain about you; abide by the terms of
this notice; notify you if we are unable to agree to a requested restriction; accommodate reasonable
requests you may have to communicate health information by alternative means or alternative locations.
We reserve the right to change our practices and to make the new provisions effective for all protected health information we
maintain. Should our information practices change, we will mail a revised notice to the address you supplied us. We will not use
or disclose your health information without your authorization except as described in this notice.
If you have concerns regarding your privacy, please contact our privacy officer at 941-782-4299. If you believe your privacy
rights have been violated, you can file a complaint with the Secretary of Health and Human Services. There will be no retaliation
for filing a complaint.
Being Prepared – Plan Ahead for Health Care:
Florida law guarantees the right of every adult in Florida to make certain decisions concerning his or her medical treatment. The
law also allows you to issue “advance directives” for your rights and wishes to be respected even when you are too sick to make
decisions yourself. If you would like more information about “Advance Directives”, please ask your counselor.
2 Manatee Glens Inpatient Handbook
MANATEE GLENS HOSPITAL AND ADDICTION CENTER
SUMMARY OF THE FLORIDA PATIENT’S BILL OF RIGHTS AND RESPONSIBILITIES
Florida law requires that your health care provider or health care facility recognize your rights while you are receiving medical care
and that you respect the health care provider’s or health care facility’s right to expect certain behavior on the part of patients. You may
request a copy of the full text of this law from your health care provider or health care facility.
A Patient has the Right to:
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Be treated with courtesy and respect, with appreciation of his or her individual dignity, and with protection of his or her need
for privacy.
A prompt and reasonable response to questions and requests.
Know who is providing medical services and who is responsible for his or her care.
Know what patient support services are available, including whether an interpreter is available if he or she does not speak
English.
Know what rules and regulations apply to his or her conduct.
Be given by the health care provider information concerning diagnosis, planned course of treatment, alternatives, risks, and
prognosis.
Refuse any treatment, except as otherwise provided by law.
Be given, upon request, full information and necessary counseling on the availability of known financial resources for his or
her care.
Know upon request and in advance of treatment, whether the health care provider or health care facility accepts the Medicare
assignment rate.
Receive, upon request, prior to treatment, a reasonable estimate of charges for medical care.
Receive a copy of a reasonably clear and understandable, itemized bill and, upon request, to have the charges explained.
Impartial access to medical treatment or accommodations, regardless of race, national origin, religion, physical handicap, or
source of payment.
Treatment for any emergency medical condition that will deteriorate from failure to provide treatment.
Know if medical treatment is for purposes of experimental research and to give his or her consent or refusal to participate in
such experimental research.
Express grievances regarding any violation of his or her rights, as stated in Florida law, through the grievance procedure of
the health care provider or health care facility which served him or her and to the appropriate state licensing agency.
Contact the Suncoast Region Substance Abuse & Mental Health program office at 813-337-5700 or Disability Rights
Florida (800) 342-0823.
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Be free from abuse and neglect; privacy to report any possible abuse or neglect to Florida Abuse Hotline
(800) 96-ABUSE, Florida Health Partners may contact the Area 6 Medicaid Office.
Additional Rights for Inpatient and Residential
You have the RIGHT to:
 Reside in Manatee Glens’ facilities which are comfortable and safe, promote dignity and ensure privacy;
 Send and receive unopened mail. If you are in an inpatient facility and you do not have resources for stamps and writing
materials, they will be provided for you. We reserve the right to limit stamped items to 2 per day;
 Have religious worship;
 Wear and use your own clothing and personal articles except for those things of large value and dangerous items, which will
be stored for safekeeping and returned to you when you leave;
 Have reasonable individual storage space;
 Have reasonable protection of privacy in toileting and bathing;
 Have visitors according to established program policy unless otherwise ordered by the attending physician;
 Be free from restraints and/or isolation except in emergency situations and then only when the health or safety of yourself
and others are in question. This procedure is only permitted in the Hospital and Crisis Unit;
 Have well balanced, regular and nutritious meals;
 Manage your own money unless otherwise court ordered;
 Vote in public elections, if eligible.
3 Manatee Glens Inpatient Handbook
MANATEE GLENS HOSPITAL AND ADDICTION CENTER
SUMMARY OF THE FLORIDA PATIENT’S BILL OF RIGHTS AND RESPONSIBILITIES
A patient is Responsible for:
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Providing to the health care provider, to the best of his or her knowledge, accurate and complete information about presenting
complaints, past illnesses, hospitalizations, medications, and other matters relating to his or her health.
Reporting unexpected changes in his or her condition to the health care provider.
Reporting to the health care provider whether he or she comprehends a contemplated course of action what is expected of
him or her.
Following the treatment plan recommended by the health care provider.
Keeping appointments and when unable to do so for any reason notifying the health care provider or health care facility at
least 24 hours before scheduled appointment. If you do not call, you may be charged for appointment.
His or her actions if he or she refuses treatment or does not follow the health care provider’s instructions
Assuring that the financial obligations of his or her health care are fulfilled as promptly as possible.
Following health care facility rules and regulations affecting patient care and conduct including taking any medications
prescribed.
Keeping any personal information that is shared in group meetings confidential including names of other participants.
The following statements apply to clients who live in any Manatee Glens residences.
You have the responsibility to:
 Make reasonable use of telephones so as to allow others the chance to make calls;
 Show respect for the privacy of others;
 Not to use alcohol or drugs other than prescribed medications;
 Maintain the schedule;
 Keep your living area clean and neat;
 Maintain appropriate personal cleanliness.
Responsibility Regarding Medication
You have the responsibility to:
 Take the medication which has been prescribed for you according to the instructions given by the physician;
 During your appointment, tell your physician and nurse about any reactions to the medications you take;
 Tell the physician all you know about any physical health problems and about your medication history, which includes bad
reactions or allergies to medicines;
 Tell us about any physical health problems.
Client Emergencies: A client emergency is defined as a sudden unforeseen situation requiring prompt action to
avoid the risk of serious injury. This may include active thoughts of suicide, homicide, or severe medication
reactions.
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For all medical emergencies please dial 911
National Suicide Prevent Lifeline 1-800-273-8255.
Emergency Assessments are available 24/7 through our Access Center located at 2020 26th Ave. East, Bradenton,
FL (941) 782-4617
When an individual has concerns about client care & safety in the organization, they may contact their current service
provider, program manager, or our grievance coordinator at 941-782-4100. They may also contact The Joint Commission by
calling 800-994-6610 or email complaint@jointcommission.org for any concerns the organization has not addressed. If you have a
complaint against a hospital or healthcare professional, call the Consumer Assistance Unit at 888-419-3456.
4 Manatee Glens Inpatient Handbook
Rights of Persons
In Mental Health Facilities and Programs
The following rights are guaranteed to you under Florida law. These will be fully explained to you at the time of and
following admission to this facility. A copy of this form will be given to you to keep. You have the right to read the Baker
Act law and rules at any time. Your signature on the form, if you choose to sign, only acknowledges that you have had the
rights explained and that a copy of this form was provided to you.
Individual Dignity
You have the right to individual dignity and access to all constitutional rights. The federal Americans with Disabilities Act
(ADA) applies to persons in this facility.
Right to Request Discharge by Persons on Voluntary Status
If you request discharge, your doctor will be notified and you will be discharged within 24 hours from a designated
community facility and within 3 working days from a state hospital, unless you withdraw your request or you meet the
criteria for involuntary placement. If you meet the criteria for involuntary inpatient placement or involuntary outpatient
placement, the hospital administrator must file a petition with the Court for your continued stay within two (2) working
days of your request for discharge.
Designation of Representative
You will be asked to identify a person to be notified in case of an emergency. Further, if you are at this facility for
involuntary examination and do not have a guardian appointed by the court, you will be asked to designate a person of
your choice to receive notification of your presence in this facility, unless you request that no notification be made. If you
do not or cannot designate a representative, a representative will be selected for you by the facility from a prioritized list
of persons. You have the right to be consulted about the person selected by the facility and you can request that such a
representative be replaced.
Communication
You have the right to communicate openly and privately by phone, mail, or visitation with persons of your choice during
your stay at this facility. You have the right to make free local calls and will be given access to a long distance service for
collect calls. If communication is restricted, you will be given a written notice including the reasons for the restrictions.
This facility is required to develop reasonable rules governing visitors, visiting hours, and the use of telephones but you
cannot be limited in your access to your attorney, to a phone for the purpose of reporting abuse, or in contacting the
Disability Rights Florida. Several toll-free telephone numbers you may wish to keep are:
Florida Abuse Registry
1 800 96-ABUSE or (800) 342-9152
Disability Rights Florida
1 800 342-0823
Confidentiality of Information and Records
Information about your stay in this facility is confidential and may not be released, except under special circumstances,
without your consent (or the consent of your guardian or guardian advocate or health care surrogate/proxy if you have
one). Special circumstances include release of information to your attorney, in response to a court order, to an aftercare
treatment provider, or after a threat of harm to another person. You have the right of reasonable access to your clinical
record unless such access is determined to be harmful to you by your physician.
Treatment
You have the right to receive the least restrictive, available, appropriate treatment in this facility. You will get a physical
examination within 24 hours of arrival and you will be asked to help develop a treatment plan to meet your individual
needs. The criteria, procedures, and required staff training used by this facility for restraints, seclusion, isolation,
emergency treatment orders, close levels of supervision, or physical management are available for your review. Such
interventions may never be used for punishment, convenience of staff, or to compensate for inadequate staffing.
Advance Directives
You have the right to prepare an advance directive when competent to do so that specifies the mental health care you want
or don’t want and to designate a health care surrogate to make those decisions for you at the time of crisis. The facility is
required to make reasonable efforts to honor those choices or transfer you to another facility that will honor your choices.
The facility must document whether you have an advance directive and inform you of its policies about advance
directives. There are organizations that can help you prepare an advance directive.
CF-MH 3103, Feb 05 (obsoletes previous editions) (Recommended Form)
5 Manatee Glens Inpatient Handbook
BAKER ACT
(Continued Over)
Rights of Persons
In Mental Health Facilities and Programs (page 2)
Informed Consent
Before any treatment is given to you, you will be given information about the proposed treatment, the purpose of the
treatment, the common side effects of medication you receive, alternative treatments, the approximate length of care, and
that any consent given may be revoked at any time by you, your guardian your guardian advocate, or your health care
surrogate/proxy. There are additional disclosures that must be made for mediations you receive. If the treatment for
which you have given consent is changed at any time during your stay in this facility, it will be fully explained by the staff
prior to asking for your written consent to the revised treatment.
Clothing and Personal Effects
You have the right to keep your clothing and personal effects unless they are removed for safety or medical reasons. If
they are taken from you, an inventory of the possessions will be prepared and given to you to sign. The possessions will
be immediately returned to you or your representative upon your discharge or transfer from this facility.
Habeas Corpus
You or your representative has the right to ask the Court to review the cause and legality of your detention in this facility
or if you believe you have been unjustly denied a legal right or privilege or an authorized procedure is being abused. A
petition form will be given to you by staff upon your request. If you wish to file a habeas corpus petition, you can submit
it to a facility staff member, and it will be filed with the court for you by the facility no later than the next court working
day.
Voting
You have the right to register to vote and to cast your vote in any elections unless the court has removed this right from
you. Staff will assist you in arranging for registration or voting.
Discharge
You have the right to seek treatment from the professional or agency of your choice after your discharge from this facility.
____________________________________________________________
Person’s Signature
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Date
____________
Time
am pm
____________________________________________________________
Signature, if applicable, of
Guardian
Guardian Advocate
Representative
Health Care Surrogate/Proxy
____________________ ____________
Date
Time
am pm
____________________________________________________________
Witness Signature
____________________ ____________
Date
Time
am pm
This form must be retained in the clinical record as a receipt that the person received notice of his/her rights at the
time of admission. A copy must be given to the person and to any authorized decision-maker for persons
incompetent or incapacitated by age or disability.
cc: Check when applicable and initial/date/time when copy provided
Individual
Date Copy Provided
Time Copy Provided
Person
am pm
Guardian
am pm
Guardian Advocate
a m pm
Representative
am pm
Health Care Surrogate/Proxy
am pm
See s. 394.459, 394.4615, Florida Statutes
CF-MH 3103, Feb 05 (obsoletes previous editions) (Recommended Form)
6 Manatee Glens Inpatient Handbook
Initials of Who
Provided Copy
BAKER ACT
MANATEE GLENS HOSPITAL AND ADDICTION CENTER
All clients admitted to Manatee Glens Hospital and Addiction Center receive a copy of CF-MH 3103 or equivalent
document upon admission as required by Rule 65E-5.140(1). All clients sign a Statement of Receipt indicating receipt of
this Handbook.
All staff are trained to protect client rights guaranteed in FS 394.459 and Chapter 65E-5.
If you are 18 years of age or older, you have the right to request services.
If you are under 18 years of age, you must have the permission of a parent or guardian to receive services unless:
 The services provided are in the area of drug or alcohol addiction.
 You are over thirteen years of age and in a crisis.
Client-Related Work: Rehabilitative work-related activities may be a part of your program. All work performed that is voluntary,
must be justified by the treatment plan and all wages, if any, are in accordance with applicable wage and disability laws and
regulations.
Areas of Manatee Glens facilities are equipped with video cameras/audio monitoring as required by Florida Statute and /or to maintain
client and staff safety. All monitors are in a location restricted to staff.
CLIENT COMPLAINT & GRIEVANCE PROCEDURE
Client Complaint:
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A complaint is any verbal or written expression of dissatisfaction with any aspect of Manatee Glens’ service which is not
immediately resolved to your satisfaction.
Complaints may be given to any Manatee Glens employee who will forward the complaint to the Client Services
Representative for the facility.
Complaints will be reviewed with input from the appropriate manager and you will receive a response within thirty (30)
working days.
If the complaint cannot be resolved within thirty (30) working days, a mutually agreeable extension is decided upon and a
letter is sent to you upon resolution. If you do not agree with the resolution, you may file a grievance, preferably within
fourteen (14) days.
Client Grievance:
A grievance is defined as any complaint, which is not resolved to your satisfaction, or any allegations of illegal or unethical behavior.
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Grievances may be given to any Manatee Glens employee who will forward the grievance to the Grievance Coordinator.
The Grievance Coordinator works with senior management to resolve your grievance within five (5) working days but has up
to sixty (60) working days from the initial notification date to resolve the grievance.
If the grievance cannot be resolved in five (5) working days, the Grievance Coordinator will contact you to establish a
mutually agreed upon extension.
When the grievance is resolved, you will receive a copy of the resolution.
If you are not satisfied with the resolution you may:
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Send the grievance to the Manatee Glens Client Grievance Committee for review. Within ten (10) days a report with
recommendation(s) will be sent to the President/CEO. Within five (5) working days of receipt of the committee report the
President/CEO will reach a decision. You will receive a copy of the decision and a copy will be sent to the Department of
Children and Families Service Representative or external advocate when applicable.
Send an additional appeal to the Board of Directors of Manatee Glens. The Chairperson of the Board will send you a
response following the Board’s next regularly scheduled monthly meeting. A copy of the Board’s decision will be forwarded
to the President/CEO of Manatee Glens, the Department of Children and Families Service Representative or external
advocate when applicable. The President/CEO will relay the Board’s written decision to you within five (5) working days of
receipt. The decision of the Board of Directors is final.
To request a complaint form, see any Manatee Glens staff.
7 Manatee Glens Inpatient Handbook
MANATEE GLENS INPATIENT AND ADDICTION CENTER
Seclusion /Restraints: Applies to Hospital and Crisis Center
Manatee Glens is a Joint Commission Accredited Health Care Facility. Our goal is to create a physical, social, and cultural
environment to limit seclusion and restraint use to clinically appropriate and adequately justified situations. Our hospital’s approach
to seclusion and restraint is always to protect the patient’s health and safety and preserve his or her dignity, rights and wellbeing.
Seclusion and restraints are used in response to emergent, dangerous behavior and when it is essential to protect patients from harming
themselves, other patients or staff.
While in seclusion or restraints a patient will never be left alone. There will always be staff observer assigned to stay with them until
they can rejoin the patient community. Prior to resorting to such safety measures every effort is made to redirect behavior. Seclusion
and /or restraint may only be prescribed by a physician and only when less restrictive alternatives have been tried and documented as
ineffective or there is imminent danger to self or others.
Employees at Manatee Glens Hospital are trained annually in the areas of verbal de-escalation, management of aggressive and violent
behavior and the care of patients in seclusion and restraints.
Policies and procedures regarding seclusion and restraint can be found at the Nurses Station on each nursing unit. Those policies
cover every aspect of this safety procedure including patient rights, management of aggressive behavior, doctors orders, proper care of
a patient in seclusion or restraint, etc. If you would like to read these policies, simply ask the Charge Nurse of the unit you are
admitted to.
Our desire is to become a restraint free facility. We ask for your assistance and support to achieve our goal. If you are the patient or
family member, you can help by providing our health care staff with information that will help calm the patient when he/she is having
a difficult time or losing control.
Seclusion is defined as: the physical segregation of a person in any fashion or involuntary isolation of a person in a room or area from
which the person is prevented from leaving. The prevention may be by physical barrier or by a staff member who is acting in a
manner, or who is physically situated, so as to prevent the person from leaving the room or area.
Restraint is defined as: a physical device, method, or drug used to control behavior. A physical restraint is any manual
method or physical or mechanical device, material, or equipment attached or adjacent to the individual's body so that he or
she cannot easily remove the restraint and which restricts freedom of movement or normal access to one's body. Examples
of behavior that may lead to the use of restrictive safety measures include:
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Hitting
Kicking
Inappropriate sexual behaviors
Self-mutilating (pinching, scratching,
cutting, hitting self)
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Throwing
Hair Pulling
Uncontrolled threatening verbal/
Non-verbal behaviors
In the event that the safety measure of seclusion or restraint is required, you will be provided an option to request that a family
member be notified. Please discuss this option with your family and inform the charge nurse of your wishes.
It is our wish to provide you and your loved ones with the best possible mental health/substance abuse care available. We thank you
for your time and attention to this matter and wish you a quick and early recovery.
Infectious Diseases:
Florida law prohibits health care facilities from discriminating against persons with infectious diseases who are in need of mental
health or drug treatment services. Therefore, Manatee Glens facilities may occasionally admit persons with various infectious
diseases including HIV, which is a factor in AIDS. Facility personnel follow strict procedures to minimize the potential to spread
disease to our clients and our staff. You can protect yourself and help avoid the spread of any infectious diseases by following these
guidelines:
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Refrain from sexual activity with any person at the facility
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Do not touch another person’s bodily fluids, open sores or mucous membranes
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Do not share eating utensils, toothbrushes, drinking cups, or cigarettes
8 Manatee Glens Inpatient Handbook
If you have any questions regarding these instructions, please discuss them with your doctor, a facility nurse or your case
coordinator.
History of the Baker Act
It’s Development & Intent
History
In 1971 the Florida Legislature passed into law the Florida Mental Health Act, which went into effect July 1 of the
following year. This Act brought about a dramatic and comprehensive revision of Florida’s 97-year old mental health
laws. It substantially strengthened the due process and civil rights of persons in mental health facilities.
Statutes governing the treatment of mental illness in Florida date back to 1874. Before the Baker Act was enacted, a
person could be placed in a state hospital if three people signed affidavits and secured the approval of a county judge. The
law stated that the committing judge was required to have any destitute person with mental illness committed to the sheriff
for safekeeping until transferred to the hospital. Children as young as 12 years old could be placed into state hospitals with
adults. Payment could be required from friends, parents or guardian for the person’s care. Persons hospitalized in private
or public hospitals were allowed only one individual with whom he or she could openly and privately correspond. There
was no specific period of commitment before a person’s confinement would be reconsidered by a judge.
The Baker Act prohibited the indiscriminate admission of persons to state institutions or the retention of persons without
just cause. The Baker Act mandated court-appointed attorneys to represent each person for whom involuntary placement
was sought and provided for independent reviews every six months of all involuntary placements. The new law
established a patients’ bill of rights, protecting persons’ rights to communicate with whomever they wished, to receive and
send unopened mail, to use their own possessions, and to vote, among many other rights. The law also prohibited the
placement of persons with mental illnesses in jails, unless they had committed criminal acts.
The Act, usually referred to as the “Baker Act,” was named after Maxine Baker, former State Representative from Miami
who sponsored the Act, after serving as chairperson of the House Committee on Mental Health. According to
Representative Baker, the intent of the Act was to encourage voluntary commitments as opposed to involuntary (when the
person was competent to consent), to separate the process of hospitalization from the process of legal incompetency, to
increase community care of persons with mental illnesses, and to facilitate persons’ return to normal community life.
Referring to the treatment of persons with mental illness before the passage of her bill, Representative Baker stated “ In
the name of mental health, we deprive them of their most precious possession – liberty.”
History of the Baker Act – It’s Development and Intent State of Florida Department of Children and Families Mental
Health Program Office Florida’s Baker Act Website – May 2002 2 Since the Baker Act became effective in 1972, a number of
legislative amendments have been enacted to further protect persons’ civil and due process rights. The most substantial reform
occurred in 1996 when greater protections were extended to persons seeking voluntary admission, informed consent and guardian
advocacy provisions were strengthened, notice requirements were expanded, and suspension and withdrawal of receiving and
treatment facility designations was specified, among many other revisions.
Related Legislation
It is important that the Baker Act only be used in cases where the person has mental illness and meets all remaining criteria for
voluntary or involuntary admission. The Baker Act is the Florida Mental Health Act and it does not serve any other purpose. For many
persons, the use of other statutes may be more appropriate. Alternatives may include:
• Developmental Disabilities, Chapter 393, F.S.
• Marchman Act, (Substance Abuse Impairment), Chapter 397, F.S.
• Emergency Examination and Treatment of Incapacitated Persons Act, Chapter 401.445, F.S.
• COBRA/EMTALA Federal “Anti-Dumping” law, 42 USC 1395dd
• Access to Emergency Services and Care, Chapter 395.1041, F.S
• Adult Abuse, Neglect, and Exploitation, Chapter 415.1051, F.S.
• Advance Directive, Chapter 765, F.S.
• Guardianship, Chapter 744, F.S.
9 Manatee Glens Inpatient Handbook
Intent of the Baker Act
The Baker Act is intended to:
• Provide comprehensive services for persons requiring intensive short-term and continued treatment
• Provide emergency service and temporary detention for evaluation when required
• Admit persons to treatment facilities on a voluntary basis when extended or continuing care is needed and
unavailable in the community
• Ensure that any involuntary examination or treatment be accomplished in a setting which is clinically appropriate
and most likely to facilitate the person’s return to the community as soon as possible
• Guarantee that the individual dignity and human rights of all persons who are admitted to mental health facilities for
examination or placement are protected.
• Employ the least restrictive means of intervention based on the individual needs of each person, within the scope of
available services.
Protections of the Baker Act
The Baker Act protects all persons with serious mental illnesses in the State of Florida. These include:
• Persons on voluntary and involuntary status
• Persons of all ages, including children and elders.
• Persons who are competent and those who have been determined to be incompetent or incapacitated
• Persons who are poor and those who can afford private care
• Persons who are hospitalized in a facility and those treated on an outpatient basis.
The Baker Act was considered by many persons around the country as landmark legislation at the time of its enactment.
The movement to deinstitutionalize persons from large mental hospitals back to their home communities became
prominent since the 1970’s and many newer psychiatric medications have made it possible for persons to avoid or reduce
the need for long-term hospitalization. Since the passage of the Act, the rights of individuals to live freely and without the
same degree of deprivation of liberty has been more accepted by the public. The Baker Act has been continuously revised
to recognize these trends and to protect the rights of persons with mental illnesses.
Voluntary Admissions
s. 394.4625, F.S. Chapter 65E-5.270, F.A.C.
The Baker Act encourages the voluntary admission of persons for psychiatric care, but only when they are
able to fully understand the decision and its consequences and are able to fully exercise their rights for themselves.
When this is not possible due to the severity of the person’s condition, the law requires that the person be
extended the due process rights assured for those under involuntary status.
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“Mental Illness” s. 394.455, F.S means an impairment of the mental or emotional processes that exercise
conscious control of one’s actions or of the ability to perceive or understand reality, which impairment
substantially interferes with a person’s ability to meet the ordinary demands of living, regardless of etiology. For
the purposes of this part, the term does not include retardation or developmental disability as defined in Chapter
393, intoxication, or conditions manifested only by antisocial behavior or substance abuse impairment.
“Express and informed consent” means consent voluntarily given in writing, by a competent person, after
sufficient explanation and disclosure of the subject matter involved to enable the person to make a knowing
and willful decision without any element of force, fraud, deceit, duress, or other form of constraint or coercion.
“Incompetent to consent to treatment” means that a person’s judgment is so affected by his or her mental
illness that the person lacks the capacity to make a well- reasoned, willful, and knowing decision concerning his
or her medical or mental health treatment.
In general, a person cannot be admitted as “voluntary” unless competent to provide express informed consent. Hence,
persons who cannot provide express and informed consent are admitted only under the heightened protections established
for persons on involuntary status.
10 Manatee Glens Inpatient Handbook
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Certain person must be assessed for their ability to provide express and informed consent to voluntary admission
prior to being removed from their residence and transported to a receiving facility. They include persons over 60
years of age with dementia from specified facilities, persons over 60 years of age who are transferred on an
emergency basis from a nursing home, and persons for whom health care decisions are currently being made by a
health care surrogate or proxy.
Baker Act receiving facilities may not admit under voluntary status incapacitated persons who have court
appointed guardians and may not allow a health care surrogate or proxy of a person on voluntary status to provide
consent to treatment.
Prior to giving consent to admission or treatment, the following information must be given to the person or their legally
authorized substitute decision-maker.
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The reason for admission
The proposed treatment
The purpose of the treatment to be provided
The common side effects thereof
Alternative treatment modalities
The approximate length of care
That any consent may be revoked prior to or during the treatment period
Any person admitted on voluntary basis must be evaluated within 24 hours after arrival at a receiving facility by a
physician to document the person’s competence to provide express and informed consent for admission. If the person
refuses or revokes consent to treatment or is found to be unable to make well-reasoned, willful, and knowing decisions,
the person must be discharged or a petition for involuntary placement filed with the circuit court.
Persons on voluntary status who request discharge or who refuse or revoke consent to treatment must be discharged from
a community-based Baker Act receiving facility within 24 hours, and from a state treatment facility within 3 working
days, unless the facility administrator files a petition for the person’s involuntary placement with the circuit court.
Involuntary Examination
s.394.463,F.S. Chapter 65E-5.280,F.A.C.
A person may be taken to a receiving facility for involuntary examination if there is reason to believe that the or she is
mentally ill as defined in the law, and because of his or her mental illness:
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The person has refused voluntary examination or is unable to determine whether examination is necessary; and
Without care of treatment, the person is likely to suffer from neglect resulting in real and present threat of
substantial harm that can’t be avoided through the help of others; or
There is substantial likelihood that without care or treatment the person will cause serious bodily harm to self or
others in the near future, as evidenced by recent behavior.
An involuntary examination may be initiated by any one of the three following means:
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A circuit court may enter an ex parte order, based upon sworn testimony, directing a law enforcement officer to
take the person to the nearest receiving facility. A law enforcement officer may serve and execute an ex parte
order on any day of the week, at any time of the day or night and may use such reasonable physical force as is
necessary to gain entry to take custody of the person.
A law enforcement officer shall take a person who appears to meet the above criteria into custody and deliver the
person to the nearest receiving facility. The officer shall execute a written report detailing the circumstances
under which the person was taken into custody, and the report shall be made part of the person’s clinical record.
A physician, clinical psychologist, psychiatric nurse or clinical social worker, each as defined in the statute, may
execute a certificate stating that he or she has examined a person within the preceding 48 hours and finds that the
person appears to meet the criteria for involuntary examination and stating the observations upon which that
conclusion is based. A law enforcement officer shall take the person into custody and deliver him or her to the
nearest receiving facility and shall execute a written report detailing the circumstances under which the person
was taken into custody.
11 Manatee Glens Inpatient Handbook
When a law enforcement officer has custody of a person based on either non-criminal or minor criminal behavior and who
meets the statutory criteria for involuntary examination, the officer shall transport the person to the nearest receiving
facility for examination. When an officer has arrested a person for a felony and it appears that the person meets the
statutory criteria for involuntary examination, the person shall first be process in the same manner as any other criminal
suspect.
An officer may request assistance from emergency medical personnel if such assistance is needed for the safety of the
officer or the person in custody. If the officer believes that a person has an emergency medical condition as defined in
law, the person may be first transported to a hospital for emergency medical treatment, regardless of whether the hospital
is a designated receiving facility.
A person for whom an involuntary examination has been initiated who is being evaluated or treated at a hospital for an
emergency medical condition must be examined by a receiving facility within 72 hours. The 72 hour period begins when
the person arrives at the hospital and ceases when the attending physician documents that the person has an emergency
medical condition. One of the following must occur within 12 hours after the person’s attending physician documents the
person’s medical condition has stabilized or that an emergency medical condition does not exist:
 The person can be examined by a physician or clinical psychologist at the medical hospital, and if found not to
meet the criteria for involuntary placement, released or transferred to voluntary status; or
 The person must be examined by a physician or clinical psychologist from a designated receiving facility and
released; or
 The person must be transferred to a designated receiving facility in which appropriate medical treatment is
available.
Designated receiving facilities must accept persons brought by law enforcement officers for involuntary examinations. If
appropriate under state and federal law, the person may later be transferred to another facility. Receiving facilities must
send a copy of the court order, law enforcement officer’s report, or professional’s certificate initiating the involuntary
examination (with the required cover sheet) to the Agency for Health Care Administration (AHCA) on the next working
day after the person’s arrival at the facility.
Elder protections were added in 1996 to assure that occupants of nursing homes, assisted living facilities and other
Chapter 400, F.
S., licensed facilities were competent and made knowing decisions before they could be transferred or admitted as
voluntary. The presentation of such occupants as “voluntary” after a person has been forcefully or otherwise involuntarily
removed from any licensed residential facility to receiving facility for involuntary examination requires a “next-day”
report to AHCA by the receiving facility. These reports are used to flag or track potentially inappropriate or illegal
transfers of vulnerable or confused individuals.
Upon arrival at a receiving facility, a person shall be examined without unnecessary delay by a clinical psychologist or
physician experienced in the diagnosis and treatment of mental health and nervous disorders. The person shall not be
released by the facility without the documented approval of a psychiatrist or clinical psychologist.
A person may not be held for involuntary examination longer than 72 hours. Within the 72 hour examination period, one
of the following must take place:
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The person shall be released unless charged with a crime;
The person shall be released for outpatient treatment;
The person shall be asked to give express and informed consent to voluntary placement; or
A petition for involuntary placement shall be filed with the circuit court by the facility administrator.
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Involuntary Placement
s.394.467,F.S. Chapter 65E-5.290,F.A.C.
In response to a petition for involuntary placement, a person may be involuntarily placed for treatment upon finding of the
court by clear and convincing evidence that he or she is mentally ill and because of his or her illness:
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She/he has refused voluntary placement or is unable to determine whether placement is necessary; and
She/he is incapable to surviving alone or with the help of others and without treatment is likely to suffer from
neglect which poses a real and present threat of substantial harm to his or her well-being; or
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There is substantial likelihood that in the near future she/he will inflict serious bodily harm on self or other
person, as evidenced by recent behavior causing, attempting or threatening such harm; and
All available less restrictive treatment alternatives which would offer an opportunity for improvement of his or
her condition have been judged to be inappropriate.
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Within 72 hours, or if the 72 hours ends on a weekend or holiday, no later than the next working day thereafter, a petition
for involuntary examination, must be filed by the receiving facility administrator and supported by the opinion of the
psychiatrist and the second opinion of a clinical psychologist or another psychiatrist, both of whom have personally
examined the person within the preceding 72 hours, that the criteria for involuntary placement are met (in certain rural
counties the second opinion may be provided by a physician or psychiatric nurse, both with special training and
experience as defined in the statue).
The person will have the public defender appointed by the court to represent him or her unless otherwise represented by
private counsel. The state attorney shall represent the state, rather than the petitioning facility administrator, as the real
party in interest in the proceeding. The person has the right to an independent expert examination provided by the court.
The court is required to hold the involuntary placement hearing within 5 days, unless a continuance is requested by the
person and granted by the court. The court may appoint a master to preside at the hearing. One of the two professionals
who executed the involuntary placement petition must be a witness at the hearing. At the hearing, the court must consider
testimony and evidence regarding the person’s competence to consent to treatment. If the court finds that the person is
incompetent to consent to treatment, it must appoint a guardian advocate.
If the court concludes that the person meets the criteria for involuntary placement, it must order the person to be retained
at or transferred to, or treated at an appropriate receiving or treatment facility on an involuntary basis, for a period of up to
6 months.
The administrator of a treatment facility may refuse admission to any person directed to its facilities on an involuntary
basis, whether by civil or criminal court order, who is not accompanied at the same time by adequate orders and
documentation.
Continued Involuntary Placement
s. 394.467(7),F.S. Chapter 65E-5.300, F.A.C.
If at the expiration of their placement order, a person continues to meet the criteria for involuntary placement, the
administrator is required, prior to the expiration of the period during which the treatment facility is authorized to retain the
person, to file a petition requesting authorization for continued involuntary placement. The request must be accompanied
by a statement from the person’s physician or clinical psychologist justifying the request, a brief description of the
person’s treatment during the time he/she was involuntarily placed, and an individualized plan of continued treatment.
Hearings on petitions for continued involuntary placement are administrative rather than judicial hearings and are
conducted by an administrative law judge. Unless the person is otherwise represented by counsel, he/she will be
represented at the hearing by the public defender. If at a hearing it is shown that the person continues to meet the criteria
for involuntary placement the administrative law judge will sign the order for continued involuntary placement for a
period not to exceed 6 months. The same procedure will be repeated prior to the expiration of each additional period the
person is retained.
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Discharge of Persons on Involuntary Status
s. 394.469,F.S. Chapter 65E-5.320, F.A.C.
Receiving and treatment facilities are required to discharge a person at any time the person no longer meets the criteria for
involuntary placement, unless the person has transferred, by express and informed consent, to voluntary status. If the
person being discharged is under a criminal charge, he/she must be transferred to the custody of the appropriate law
enforcement agency.
Transfer
s. 394.4685,F.S. Chapter 65E-5.310,F.A.C.
Transfers of persons with emergency medical conditions (including psychiatric and substance abuse emergencies) from
hospitals are governed by the federal EMTALA/COBRA “anti-dumping” law. If a person requires transfer from a
hospital that has provided the person evaluation or treatment for an emergency medical condition to a Baker Act receiving
facility, the transfer must take place within 12 hours after the condition has stabilized. Otherwise, under provisions of the
Baker Act, persons may transfer:
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Between public facilities, upon the request of the person or specified others upon the discretion of the department
to meet the medical or mental health treatment needs of the person or the availability of appropriate facility
resources.
From public to private facilities, upon request of the person, guardian or guardian advocate and upon acceptance
of the person by the private facility.
From private to public facilities upon request of the person, guardian, guardian advocate, or private facility, and
upon acceptance of the person by the public facility. The public facility must respond to a request for the transfer
within 2 working days after receiving the request. The cost of such transfer requested by a private facility shall be
the responsibility of the sending facility.
Between private facilities upon request of the person, guardian, guardian advocate, and upon acceptance of the
person by the facility to which transfer is sought.
Oversight
s. 394.457, F.S.
The Department of Children and Family Services is designated the “Mental Health Authority” of Florida. The
Department and the Agency for Health Care Administration (AHCA) exercise executive and administrative supervision
over all mental health facilities, programs, and services.
The Department of Children & Families (DCF) is required to report to the Agency for Health Care Administration
(AHCA) any violation of the rights or privileges of persons, or of any procedure provided by any facility or professional
license or regulated by the AHCA. The AHCA is authorized to impose any sanction authorized for violations of the
Baker Act based solely o the investigation and findings of the Department.
DCF is required to adopt rules establishing the forms and procedures relating to the rights and privileges of persons
seeking mental health treatment from designated receiving and treatment facilities. Unless designated by the Department,
facilities are not permitted to hold or treat persons on involuntary status.
The Disability Rights Florida is a private nonprofit organization that receives federal funding to protect and advocate for
the rights of persons who have disabilities. The Disability Rights Florida assists on issues that arise for persons who have
mental illness and are in or been discharged within the last 90 days from any receiving or treatment facility, assisted living
facility, jail, or prison. Its main office is in Tallahassee, but it has branch offices in several other Florida cities. The
statewide toll-free phone number is 1-800-342-0823.
14 Manatee Glens Inpatient Handbook