Section 0940-03-11-.03 - EMERGENCY TRANSFER TO MTMHI FORENSIC SERVICES PROGRAM FROM REGIONAL MENTAL HEALTH INSTITUTE(1) The Office of Forensic Services shall ensure that the emergency transfer of a service recipient from a Regional Mental Health Institute to the Forensic Services Program is expeditious, complies with statutory criteria for emergency transfer and considers the welfare and safety of the service recipient, other service recipients and staff.(2) An emergency transfer shall be approved if, and only if, all appropriate interventions have been tried and documented and deemed unsuccessful.(3) The licensed physician or licensed psychologist with health service provider designation shall make a determination that a service recipient meets all of the following criteria in order for a transfer to be considered:(a) The service recipient requires emergency care and treatment that cannot be provided by the transferring facility;(b) The transfer is in the service recipient's best interest;(c) The service recipient has a substantial likelihood of injuring himself or herself or others if not treated in a secure facility; and(d) The service recipient is not under a voluntary commitment.(4) After the licensed physician or licensed psychologist with health service provider designation determines that the service recipient meets the criteria specified in 0940-03-11-.03(3) for an emergency transfer, the Chief Officer of the referring Regional Mental Health Institute shall:(a) Telephone the MTMHI Forensic Services Program Director and the Office of Forensic Services. If after normal working hours, the Assistant Commissioner may approve the transfer.(b) Send by facsimile within two (2) hours of the verbal request for an emergency transfer the following information:1. Recommendations for transfer from the referring Chief Officer that includes the rationale for transfer and the interventions taken to treat the service recipient including, but not limited to, use of restraint or isolation, changes in medication, use of PRN medications, and/or changes in unit assignment.2. Documentation of the need for transfer from either a licensed physician with expertise in psychiatry or a licensed psychologist with health service provider designation.3. A written report of a physical examination completed by a licensed physician within the last six (6) months with an addendum within the last twenty-four (24) hours.4. The most recent risk assessment, if a forensic service recipient.(5) After receiving the documentation specified in 0940-03-11-.03(4), the Office of Forensic Services shall review the request and send this documentation with a recommendation to approve or disapprove the transfer to the Assistant Commissioner and the Commissioner.(6) Upon review of this information, the Director of the Office of Forensic Services, the Assistant Commissioner, and the Commissioner shall verbally authorize the transfer or request that further information be received prior to authorization or deny the transfer.(7) If the emergency transfer request is denied, the Forensic Coordinator at the Regional Mental Health Institute and the Office of Forensic Services shall develop an alternative safety plan and identify an appropriate period of time for the review of the safety plan. The safety plan may include, but is not limited to, behavioral modification, change in medications, and moving the service recipient to a different unit.(8) After an emergency transfer request is approved, then the Office of Forensic Services shall:(a) Convey verbally the decision to the Chief Officer of the referring facility and the Chief Officer of MTMHI;(b) Prepare a letter to the service recipient from the Commissioner of TDMHDD stating that the transfer was approved. A copy of this letter shall be sent by facsimile and by mail to both the sending and receiving Chief Officers.(9) If the emergency transfer request is approved, the Chief Officer of the referring facility shall: (a) Ensure that the service recipient receives a signed statement and a receipt of transfer notification from the referring Chief Officer notifying the service recipient of the authorized transfer;(b) Provide the service recipient with the opportunity to sign the receipt of transfer notification at the time the notice is delivered. If the service recipient refuses to sign the acknowledgement, the person who delivers the notice of the transfer shall, in the presence of a witness, write on the receipt, "refused to sign receipt." After the service recipient either signs or fails to sign the acknowledgement of receipt, it shall be co-signed by the person who delivered the notice and a witness. The completed acknowledgement of receipt shall be filed in the office of the Chief Officer;(c) Verbally contact the appropriate relative or conservator and send by mail a written notice of transfer; these contacts shall be documented in the service recipient's record;(d) Set up a teleconference between the referring physician or psychologist and the receiving physician to discuss diagnosis and medication decisions: this discussion shall be documented in the service recipient's record;(e) If the service recipient has not already been judicially committed, file a complaint for commitment under T.C.A. Title 33, Chapter 6, Part 5;(f) Notify the committing court of the transfer; and(g) Send a copy of the following documents to the Office of Forensic Services:1. A copy of the court commitment order;2. A copy of the court notification; and3. A copy of the notification of the transfer to the service recipient and to the appropriate relative or conservator.(h) Verify available suitable accommodations at the MTMHI Forensic Services Program by obtaining a confirmation number from MTMHI.(10) The service recipient shall be transferred to the MTMHI Forensic Services Program, accompanied by a copy of his or her clinical record, within twenty-four (24) hours of the receipt of the verbal approval of the transfer request and confirmation of available suitable accommodations.(11) After the service recipient is transferred, the Office of Forensic Services shall prepare a letter to the service recipient from the Commissioner of TDMHDD indicating that the continued need for treatment in the secure facility shall be determined within seventy-two (72) hours.(12) Within seventy-two (72) hours of the transfer, the treatment team at the Forensic Services Program shall make a recommendation to the Chief Officer of MTMHI about the need for continued care and treatment for up to thirty (30) days.(13) If the Chief Officer determines that there is a need for continued care and treatment for up to thirty (30) days, then the:(a) Chief Officer of MTMHI shall send written notification to the service recipient of the need for continued care and treatment up to thirty (30) days and send a copy of the notification to the Office of Forensic Services; and(b) Commissioner shall send written notice to the service recipient of the authorization of the continued need for care and treatment in the Forensic Services Program and send a copy of the letter to the referring and receiving Chief Officers.(14) If continued treatment for up to thirty (30) days at the Forensic Services Program is not needed, then the MTMHI Forensic Services Program Director shall:(a) Notify the referring Regional Mental Health Institute Chief Officer by telephone and letter;(b) Verify available suitable accommodations by obtaining a confirmation number from MTMHI;(c) Transfer the service recipient to the referring facility within twenty-four (24) hours of confirming available suitable accommodations; and(d) Notify the Office of Forensic Services by telephone and letter and send a copy of the letter to the Chief Officer of the referring Regional Mental Health Institute.(15) Within thirty (30) days of the transfer to the Forensic Services Program, the Forensic Services Program treatment team shall determine if continued care and treatment at the Forensic Services Program is required beyond thirty (30) days.(16) If the treatment team recommends continued treatment beyond thirty (30) days, then the Chief Officer of MTMHI shall:(a) Notify the service recipient by letter;(b) Request approval from the Commissioner by having the Director of the Forensic Services Program prepare a letter to the Commissioner justifying the need for continued care and treatment in the secure facility; and(c) Send copies of the letter for continued care and treatment at the Forensic Services Program to the Director of the Office of Forensic Services.(17) After receiving the letter for continued care and treatment, the Office of Forensic Services Program shall review the request and send this documentation with a recommendation to approve or disapprove the transfer to the Assistant Commissioner and Commissioner.(18) If the Commissioner approves the need for continued care and treatment beyond thirty (30) days, the Commissioner shall:(a) Send written notification to the Chief Officer of the referring facility by sending an authorization memorandum;(b) Send written notification to the Chief Officer of MTMHI by sending an authorization memorandum;(c) Send written notification to the service recipient and include a complaint form to object to the authorization; and(d) Send written notification to the appropriate relative/conservator and include a complaint form to object to the authorization.(19) If the need for continued care and treatment in the Forensic Services Program beyond thirty (30) days is approved, the MTMHI Forensic Services Program Director shall notify the committing court of the authorization for continued care and treatment in the secure facility.(20) If continued care and treatment in the Forensic Services Program beyond thirty (30) days is not recommended, the Chief Officer of MTMHI shall:(a) Send written notification to the Chief Officer of the referring facility and send a copy of the notice to the Office of Forensic Services;(b) Return the service recipient to the referring facility within of seventy-two (72) hours, excluding week-ends and holidays, of providing notice of the decision.(21) If continued care and treatment in the MTMHI Forensic Services Program beyond thirty (30) days is not recommended, the Forensic Services Coordinator of the referring Regional Mental Health Institute shall:(a) Send written notification to the appropriate relative or conservator that the service recipient has been transferred from the MTMHI Forensic Services Program to a Regional Mental Health Institute; and(b) Send written notification to the committing court that the service recipient has been transferred from the MTMHI Forensic Services Program to a Regional Mental Health Institute.(22) The MTMHI Forensic Services Program Director shall notify the Office of Forensic Services of the date of the service recipient's return to the referring facility.Tenn. Comp. R. & Regs. 0940-03-11-.03
Original rule filed March 18, 2010; effective June 16, 2010.Authority: T.C. A. §§ 4-4-103;33-1-201; 33-1-202; 33-1-203; 33-1-204; 33-1-302; 33-1-305; 33-3-301; and 33-3-701 et seq.