Resolution 2020-116RESOLUTION NO. 2020 - 1 1 F
A RESOLUTION OF THE BOARD OF COUNTY COMMISSIONERS OF
COLLIER COUNTY, FLORIDA, ADOPTING THE TRANSPORTATION
PLAN FOR ACUTE CARE SERVICES FOR ADULTS AND CHILDREN IN
COLLIER COUNTY FOR STATE FISCAL YEAR 2020-2023.
WHEREAS, in 2016, the Florida Legislature passed Senate Bill 12, requiring communities
to develop a coordinated transportation plan to serve those suffering with acute substance abuse
and mental health issues. The intent of the legislation is for communities to develop plans that
provide safe and well -coordinated transportation to the nearest designated receiving facility; and
WHEREAS, Collier County, as a member of the Department of Children and Families
Suncoast Region, and through its participation in the Community Behavioral Health Advisory
Committee, has a transportation plan in place to serve this vulnerable population; and
WHEREAS, the Board of County Commissioners desires to adopt this transportation plan
to meet the legislative requirement set forth in Senate Bill 12; and
WHEREAS, the Board of County Commissioners desires to renew this transportation plan
to meet the legislative requirement set forth in Senate Bill 12.
NOW, THEREFORE, BE IT RESOLVED BY THE BOARD OF COUNTY
COMMISSIONERS OF COLLIER COUNTY, FLORIDA, that the Collier County
Transportation Plan 2020-2023, as attached hereto and made part hereof, is hereby adopted in
accordance with Senate Bill 12.
THIS RESOLUTION ADOPTED after motion, second and majority vote favoring same,
this 14th day of July , 2020.
ATTEST, . .
D'wk,614T E: 'BR.-0GK, CLERK
B Ol�i (O
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Appr�Q"4"tt L and legality:
Jenni er A. Belped o
Assistant County At orney
BOARD OF COUNTY COMMISSIONERS
COLLIER COUNTY, FLORIDA
By:
Burt L. Saunders, CHAIRMAN
DEPARTMENT OF CHILDREN AND FAMILIES
SUNCOAST REGION
SUBSTANCE ABUSE AND MENTAL HEALTH
COLLIER COUNTY
TRANSPORTATION PLAN
2020-2023
Introduction
Purpose
Community Behavioral Health Advisory Committee
Goals/Objectives
System Capacity
Baker Act Transportation
Medical Treatment
Criminal Charges
Transportation between Facilities
System Oversight
Inter -organizational Collaboration
Index
1
Page
2
2
3
3
3
4
4
5
5
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6
7
Collier County Transportation Plan
Introduction
In accordance with Florida Statute Chapter 394, Part 1, Florida Mental Health Act or the "Baker Act",
Florida Statute Chapter 397, Hal S. Marchman Alcohol and Other Drug Services Act of 1993, and
Senate Bill 12, a plan has been developed to organize a centralized approach for access to acute care
services, and to describe how the community shall support and facilitate safe and well- coordinated
transportation to the nearest receiving facility system. This plan has been developed by community
stakeholders, as described herein, and referred to as the Collier County Community Behavioral
Health Advisory Committee (CBHAC). This transportation plan requires approval by the Collier
County Board of County Commissioners, Central Florida Behavioral Health Network (CFBHN), and
the Department of Children and Families (DCF). Upon approval, this document will serve as the
transportation plan for Collier County per legislative intent and be referred to as the Collier County
Transportation Plan (CCTP).
The Collier County Transportation plan will:
I . Describe methods of transport to a facility within the designated receiving system for
individuals subject to involuntary examination under s. 394.463 or involuntary
admission under s. 397.6772, s. 397.679, s. 397.6798, or s. 397.6811.
2. Describe the commitment to ensuring a specialized transportation system that provides an
efficient and humane method of transporting patients to receiving facilities, among receiving
facilities, and to treatment facilities.
3. Describe arrangements by which a facility may provide, in addition to required psychiatric and
addiction 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 fiailties;
4. Specify how persons shall be transported to, from, or between participating facilities when
necessary and agreed to, including persons unable to pay the expense of transportation,
pursuant to s. 394.462(2).
The plan, along with an accurate inventory of designated receiving facilities and related public
resources to provide care for persons in need of behavioral health acute care services, shall be
maintained and available to law enforcement and to first responders, per s. 394.4573(2)(b).
Purpose
In the continued best interest of persons in need of public behavioral healthcare in Collier County, it is
agreed that this plan will continue the successful established Baker Act/Marchman Act transportation
system, known as the Collier County Transportation Plan. The Plan will ensure that individuals on an
involuntary Baker Act/Marchman Act will obtain immediate access to acute care services and will reduce
the need for inter -hospital transfers for psychiatric and addiction services. Coordination of services among
providers in Collier County will meet the individualized needs of persons experiencing a behavioral
health/substance use crisis, with timely access to care.
The Plan calls for all law enforcement agencies in Collier County to transport:
1. Adults and youth on an involuntary Baker Act to the David Lawrence Center's Emergency
Services Assessment Center (ESAC).
2. Adults on an involuntary Marchman Act to Collier County Jail Center.
3. Youth under the age of 18 years on an involuntary Marchman Act to the nearest local hospital
emergency room.
The following objectives are expected to be met by establishing this Transportation Plan for Collier
County:
• Implement an integrated and coordinated system of transportation and access to psychiatric
services for children and adults under a Baker Act order and appropriate and available
substance use services for adults or children under a Marchman Act order for Collier County
• Provide specialized services to children and the elderly.
• Assist law enforcement in the efficient transport of individuals in need of services to the most
appropriate facility,
• Enhance the ability to fully utilize the capacity of acute care services in the county and reduce
the unnecessary delay of transfers between facilities.
• Ensure timely access to care, continuity of care, and provide integrated and client -centered
coordination of care among providers.
Community Behavioral Health Advisory Committee: The purpose of the Community Behavioral
Health Care Advisory Committee is to discuss the operations of the Collier County Transportation Plan
and to establish ongoing communication for the implementation of best practices and quality behavioral
health services via a community collaborative approach. The committee meets regularly to discuss
grievances, public satisfaction, and assurance of patient rights as related to this plan. The Community
Behavioral Health Care Advisory Committee is composed of, but not limited to, representatives of the
following agencies:
• Central Florida Behavioral Health Network
• City of Naples Police Department
• Collier County Emergency Medical Services.
• Collier County Sheriff's Office
• CPE Mobile Crisis Response Team
• David Lawrence Centers
• Department of Children and Families Substance Abuse and Mental Health office
• Florida Department of Corrections
• Hazelden-Betty Ford Foundation -Naples
• Marco Island Police Department
• National Alliance on Mental Illness
• NCH Healthcare System
• Park Royal Hospital
• Physicians Regional Medical Center
• Riverside Behavioral Health Center
• The Willough of Naples
System Capacity
• David Lawrence Centers (DLC), located at 6075 Bathey Lane, Naples, FL is a public receiving
facility licensed by the Agency for Health Care Administration (AHCA) to operate 30 Crisis
Stabilization Unit beds for adults and minors. DLC also operates a 12-bed adult substance use
detox facility, and 18 adult substance use residential beds. At all times, DLC will maintain the
current number of publicly funded beds serving the needs of Collier County residents.
• NCH Healthcare System (NCH) and Physicians Regional Medical Center (PRMC) are not
receiving facilities, but are responsible to evaluate, treat and transfer persons in need of mental
health and addiction treatment as part of their emergency departments. This is in accordance with
federal Emergency Medical Treatment and Labor Act (EMTALA) emergency care rules and the
medical treatment aspect of the plan applies to NCH and PRMC,
• The receiving facilities within the County, and in nearby sister counties will notify the
Community Behavioral Health Advisory Committee of any changes in system capacity.
Overflow: The David Lawrence Center (DLC) CSU is licensed by the Agency for Health Care
Administration for a specified number of beds for adults and children. At no time will the David
Lawrence Center's census status prevent the acceptance of a law enforcement Baker Act. DLC
and local community hospitals will follow Florida Statutes and EMTALA regulations regarding
the care of individuals at the hospital who are under the Baker Act when a bed is not available at
the CSU.
Baker Act Transportation
• Law enforcement agencies in Collier County will remain the responsible parties to transport those
individuals in need of mental health services under the Baker Act to the nearest receiving facility.
Transportation to, from, or between facilities may be required due to several factors, including
medical necessity, inpatient acute care capacity, or individual choice. The receiving facility, and
the facility that the person is being transported to or from shall coordinate these transportation
arrangements.
If an individual has a medical issue that needs to be addressed or an intoxication level that is
medically compromising, Emergency Medical Services are required to transport the individual
being detained under a Baker Act order to the nearest emergency care center for medical
stabilization. When the individual has been stabilized and has been accepted by the Baker Act
receiving facility, the Baker Act receiving facility will notify law enforcement to transport the
individual to the receiving facility as outlined below.
Once an individual has been medically cleared by the hospital and accepted by the receiving
facility:
• Individuals under the Baker Act will be transported to the Bathey Lane campus of David
Lawrence Center by the Collier County Sheriff's Office, unless an active felony criminal charge
is present, which requires transfer to the Collier County .Tail (see Criminal Charges section
below).
• Adults under the Baker Act who are medically stabilized and who have Medicare insurance will
be offered transfer to the nearest Medicare -receiving facility (e.g., Park Royal Hospital or
Riverside Behavioral Hospital) utilizing contracted transportation services such as Ambitrans or
Medicab, or via DLC staff transportation.
Medical Treatment
The Community Behavioral Health Advisory Committee will review medical exclusionary guidelines for
the receiving facility that will be used to assist in determining the most appropriate inpatient setting for
psychiatric patients requiring hospitalization. These guidelines will be shared among all the community
partners to ensure that individuals who are assessed to need medical care are treated in an emergency care
center or medical facility,
When medically necessary, persons are treated for high -risk physical health care conditions either at an
emergency department or appropriate health care facility (either NCH Health Care System or Physicians
Regional Medical Center). In the event a person arrives at an emergency room, it is the expectation that
the hospital will abide by federal Medicare Guidelines Section 1867, (COBRA) Examination and
Treatment for Emergency Medical Conditions and Women in Labor (EMTALA) to screen, examine,
stabilize, treat and transfer individuals appropriately. In turn, the designated receiving system shall work
with the emergency department to coordinate the ongoing care of the individual, whether it is an
outpatient discharge or referral or inpatient treatment.
Criminal Charl4es:
4
Law enforcement will be required to transport individuals in need of mental health services under the
Baker Act directly to the Collier County Jail if charged with a felony crime. If charged with a
misdemeanor, the arresting law enforcement agency will transport the individual directly to the
appropriate receiving facility with the required "Jail Hold" form.
Once the individual charged with a felony has completed the booking procedure, the Jail medical
personnel will be required to notify the receiving facility of the nature of the crime and to request prior
approval before arranging a transfer. The receiving facility will review each felony Baker Act referral
case -by -case to ensure that the facility can safely manage the needs of the individual. The Baker Act
facility may determine that the felony Baker Act referral is not appropriate for transfer/ to the receiving
facility and will provide a letter of written refusal of the Baker Act felony referral in such cases. Other
arrangements for servicing the Baker Act in these cases will be coordinated between the facilities.
Upon completion of treatment for individuals who are designated "Jail Hold" as a result of being arrested
prior to treatment, the receiving facility will be required to contact the Collier County Sheriffs Office to
arrange for transportation to the Collier County Jail.
Transportation between Facilities Post -Admission to the Receiving Fac' iw
Once an individual is in the care of the receiving facility, there may be occasions when that individual
needs to be transferred from one facility to another. If transfer is needed but a medical emergency is not
present, the Baker Act receiving facility will arrange for trained staff from the facility to provide
transportation when indicated, to include arranging for transfer to the State Hospital facility. For
individuals transferred out of county to a private facility based on choice, the receiving facility will
coordinate transfer arrangements with contracted approved transportation providers and in coordination
with the out of county private receiving facilities. When such arrangements are not available or suitable,
trained staff from the receiving facility may provide transfer out of county to another receiving facility.
In the case of medical emergencies, the local EMS system will provide transportation to the nearest and
appropriate local hospital facility, with the Baker Act receiving facility providing a copy of the Baker Act
to accompany the individual.
When an individual needing transfer is designated as "Jail Hold," the receiving facility must contact the
local law enforcement agency to ensure an appropriate escort of the individual to the local hospital for
safety. Law enforcement is not responsible to transport individuals from one facility to another after
admission to the receiving facility unless the individual has criminal charges and is returning to jail.
System Oversieht/Accountability
In an effort to resolve complaints, grievances, and disputes which may arise during implementation of the
plan, personnel from above referenced agencies will meet. The Community Behavioral Health Advisory
Committee will implement necessary actions in response to its ongoing review and any public, Central
Florida Behavioral Health Network (CFBHN) or Department of Children and Families review.
The Suncoast Region Department of Children and Families, Substance Abuse and Mental Health Program
Office and CFBHN is responsible for providing oversight to the Transportation Plan. The Department of
Children and Families and CFBHN have the authority to resolve issues concerning the Transportation
Plan, approve interagency agreements, as well as coordinate other services needed for individuals beyond
acute care services. The Regional office also has a working relationship with the Agency for Health Care
Administration if issues arise beyond the department's authority. The Suncoast Region Substance Abuse
and Mental Health Program Office telephone number in Tampa is 813-337-5700.
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Interorganizational Collaboration
Implementing an effective Transportation Plan on behalf of persons in need of behavioral health services
requires a significant amount of cooperation, commitment and collaboration from all parties involved.
Besides having the strong support of law enforcement and the behavioral health providers, Collier County
hospitals have engaged in a public planning process which has strengthened the relationships between all
parties responsible for implementing the Transportation Plan in Collier County.
Index of Attachments to Collier County Transportation Plan
A. Definitions
B. Acute Care Services Overview
C. David Lawrence Mental Health Center, Inc. Certificate of Liability Insurance (Note:
Certificate will be attached with final PDF version. Includes minimum of $ I00,000 as
specified in Checklist.)
D. Collier County Sheriff's Office MOU/Transportation Plan
0
Attachment A
DEFINITIONS
Baker Act: The Florida Mental Health Act
Marchman Act: The Hal S. Marchman Alcohol and Other Drug Services Act
Receiving Facility: Any public or private facility designated by the Department of Children
and Families to receive and hold involuntary patients under emergency
conditions or for psychiatric evaluation and to provide short-term
treatment.
Private Receiving Facility: Any hospital or facility operated by a for -profit or not -for -profit
corporation or association that provides mental health services and is not
a public facility.
Public Receiving Facility: Any facility that has contracted with the Department of Children and
Families to provide mental health services to all persons, regardless of
their ability to pay, and is receiving state funds for such purpose.
Law Enforcement: Means any person who is elected, appointed, or employed full time by
any municipality or the state or any political subdivision thereof; who is
vested with authority to bear arms and make arrests; and whose primary
responsibility is the prevention and detection of crime or the enforcement
of the penal, criminal, traffic, or highway laws of the state. This
definition includes all certified supervisory and command personnel
whose duties include, in whole or in part, the supervision, training,
guidance, and management responsibilities of full-time law enforcement
officers, part-time law enforcement officers, or auxiliary law
enforcement officers but does not include support personnel employed
by the employing agency.
Law Enforcement A ee ncies
Serving Collier County:
Collier County Sheriffs Office
Naples Police Department
Marco Island Police Department
Florida Highway Patrol
Seminole Police Department
Attachment B
Acute Care Services
A. INTRODUCTION
David Lawrence Mental Health Center Inc. d.b.a. David Lawrence Centers is a private, not -for -
profit community mental health center whose primary mission is to provide a wide range of mental
health, alcohol and substance abuse services to meet the needs of the citizens of Collier County.
David Lawrence Centers' mission is restoring and rebuilding lives by providing compassionate,
advanced, and exceptional mental health, substance use, and integrated healthcare solutions,
available to all. The vision of the David Lawrence Centers is to lead the way in transformational
care so every individual assisted can achieve what is possible. David Lawrence Centers' Board of
Directors and management staff are committed to a planning and performance improvement
process consistent with the overall mission of the agency.
Emergency Services Assessment Center (ESAC) is staffed with Emergency Service (ES) clinicians
who are available to provide clinical triage services for emergency referrals. Services include Crisis
Assessment, Risk Assessment, Crisis Intervention, Crisis Support referral for Urgent Care Services
or other appropriate service(s) within or outside the agency, and/or referral for admission to an
appropriate Acute Care Unit. The Emergency Services Assessment team works collaboratively
with the Acute Care team, where ongoing clinical triage/assessment occurs off hours and on
weekends. The ESAC serves as the Collier County Baker Act receiving facility.
The Adult Crisis Stabilization Unit (CSU) is a 19-bed, locked, non -hospital inpatient mental health
unit that provides brief voluntary and involuntary evaluation and stabilization treatment services
for individuals experiencing a psychiatric crisis who meet the criteria defined under the Florida
Mental Health Act,
The Children's Crisis Stabilization Unit (CCSU) is an 11-bed, locked, non -hospital inpatient
mental health unit, which provides brief voluntary and involuntary evaluation and stabilization
services for children who are in a psychiatric crisis.
B. REFERRAL SERVICES
Emergency Services Assessment Center, Adult & Children's Crisis Stabilization Unit;
Referrals to the Emergency Services Assessment Center (ESAC) include self -referrals,
professionals within or outside of the David Lawrence Center and/or law enforcement. Individuals
may access walk-in crisis services 24 hours a day, seven days a week. ESAC provides telephone
triage and crisis intervention outside the normal business hours and during regular business hours.
Baker Act admissions and law enforcement cases are received 24/7.
Involuntary admission to the CSU may be through appropriate professionals, law enforcement or
ex -paste court orders, identified in the Florida Mental Health Act (Baker Act). The Crisis
Stabilization Units serve any person who without care or treatment of a mental illness, may cause
harm to his/herself or others as evidenced by recent behavior or who, without care or treatment, is
likely to suffer from neglect, refuse to care for his/herself, or pose a real and present threat of
substantial harm to personal well-being. Individuals admitted will be determined to meet the Baker
Act criteria, as per the Florida Mental Health Act (Ch. 394). Individuals may be admitted under
voluntary or involuntary status.
0
Parties of Agreement for COLLIER COUNTY
TRANSPORTATION PLAN
7n7n_7n7:t
Acknowledgment Form
The Collier County Sheriff's Office do hereby confirm
(Agency name)
that we have received a written copy of the Collier County Transportation Plan
2020-2023 and have reviewed and understand the plan.
COPY PROVIDED X
Collier County Sheriff's Office
Agency Name
_ r F
Print'Name
Date
Date
COPY REFUSED
�j I/-�K,;v
Attachment D
Collier County Sheriff Office MOU/ Transportation Plan
Between Collier County. Sheriff Office-....... ... (Law Enforcement
Agency), and • David Lawrence Mental Health Center Inc. �_—(Baker Act receiving facility).
In order to implement the provisions of s.394.462 Florida Statute enacted by the 2009 Florida. Legislature
governing transportation of persons. by law enforcement from a hospital to receiving facilities for
involuntary examination, or from a receiving facility to the jail, the following is required:
I. Each law enforcement agency shall develop a memorandum of understanding with each receiving
facility within the law enforcement agency's jurisdiction which reflects a single set of protocols for the
safe and secure transportation of the person and transfer of custody of the person. These protocols must
also address crisis -intervention measures.
2. Custody of a person who is transported pursuant to this part, along with related documentation, shall
be relinquished to a responsible individual at the appropriate receiving or treatment facility.
Therefore, it is agreed that:
1. Law enforcement officer shall deliver each individual under involuntary examination status to the nearest
receiving facility. This transportation plan requires approval' by the Collier County Board of County
Commissioners, Central Florida Behavioral Health Network and the Department of Children and Families.
2. The law enforcement officer will determine which receiving facility is the nearest by relying on knowledge
of the geographic area or by.requesting dispatch to use MapQuest.
3. When possible, either the officer or the Communications Center will give the facility a courtesy telephone call
to alert the staff that the officer is en route. The facility agrees that such�a courtesy call will not be used
to instruct an officer 'to take the individual to any other facility.
4. Upon arrival with the individual, the officer will complete legally required paperwork and then may
leave the individual at the receiving facility with Clinical'staff at -the Emergency Services Assessment
Center at David Lawrence Center unless the individual is being violent or combative, or the person
has serious criminal charges in addition to the involuntary examination under the Baker Act. If the
individual becomes violent or combative after the deputy leaves the receiving facility and staff reports
this to the law enforcement agency nearest to the receiving facility, a law enforcement officer will be
dispatched as soon as possible.
S. The facility to which the individual is brought by law enforcement for involuntary examination will
accept the person and conduct the examination.
6. If the facility has no available beds, or has determined that the person is in need of services from a
different facility (including medical), arrangements for a safe and appropriate transfer of the individual
to a different receiving facility/medical facility will be made by the facility that first received the
individual (See 48 below). The facility will not ask an officer to transport such an individual.
T. Transport companies used for transfers between receiving facilities and/or medical facility and receiving
facility include: Collier County EMS, Ambitrans, MediCab, David. Lawrence Center -approved staff
when indicated, or hospital -approved transportation. Safety provisions include: Appropriate Medical
equipment to meet client needs, appropriate level of supervision to ensure safety and prevent elopement.
10
S. The receiving facility will ensure that the person's safety is protected and dignity is respected through
application of all David Lawrence standards of care as written in clinical policies and procedures, the
code of ethics, quality Assurance and Improvement Plan, Safety Plan and the Client's Rights
Handbook.
9. The receiving facility will ensure that the individual receives the Mandatory Initial Involuntary
Examination prior to release, but if found to meet criteria for admission, will be admitted or transferred
to another receiving facility. If not appropriate, the individual will be released with referral to
community services as appropriate.
10. Regarding individuals with criminal or non -criminal charges in addition to the initiation of a Baker Act
involuntary examination:
a. A law enforcement officer who has custody of an individual based on a non -criminal violation or
arrested for a misdemeanor shall transport the individual to the receiving facility for examination
before booking in the jail;
b. A law enforcement officer who has arrested an individual for a felony shall book the individual into
the jail in the same manner as any other felony arrest. The jail will thereafter immediately notify a
public receiving facility, which shall be responsible for promptly arranging for the examination of
the individual, wherever the individual is held.
11. The law enforcement officer will inform facility personnel in each situation where an individual has violations or
criminal charges and the facility will not release such persons except back to the law enforcement agency that
brought the individual to the facility.
12.Other issues:
Collier Couniv Sheds
Name of Law Enforcem
Signature of Authorized
lfintedName ofAutho
Date MOU Signed b A
II
o et Receiving Facility
Si sif Auth Person for Facility
Printed Name of d Person
Date MOU S&ed by Authorized