Section 0940-03-11-.02 - REGULAR TRANSFER TO MTMHI FORENSIC SERVICES PROGRAM FROM REGIONAL MENTAL HEALTH INSTITUTE(1) The Commissioner may authorize a transfer to the Forensic Services Program at Middle Tennessee Mental Health Institute (MTMHI) of a service recipient who was admitted, committed, or hospitalized at a Regional Mental Health Institute when:(a) The service recipient can more properly be cared for and treated in the Forensic Services Program at MTMHI than at the facility where the service recipient currently receives services;(b) The transfer is in the service recipient's best interest; and(c) The Commissioner determines that the service recipient is substantially likely to injure himself/herself or others if not treated in a secure facility.(2) Upon recommendation by the treatment team, the Chief Officer of the referring facility shall prepare and send a transfer packet to the Commissioner by way of the Office of Forensic Services. The transfer packet shall, at a minimum, include: (a) A cover letter from the Chief Officer requesting the transfer with:1. The rationale for the request; and2. Documentation of the treatment interventions used to manage the service recipient's behavior in the Regional Mental Health Institute.(b) Certificate of need for transfer from a licensed physician with expertise in psychiatry or a licensed psychologist with a health service provider designation that includes documentation related to the service recipient's behavior and attempted treatment interventions including, but not limited to, the use of isolation and/or restraint, a new unit assignment, and/or changes in medication;(c) A mental status assessment/evaluation completed within twenty-four (24) hours prior to the request;(d) A physical examination completed within the last six (6) months prior to the request for transfer with an addendum verifying that a physical exam was updated within the past twenty-four (24) hours;(e) A copy of the court commitment order;(f) A copy of the most recent risk assessment, if forensic; and(g) Documentation that the service recipient and his or her conservator, spouse or responsible relative have been notified of the transfer request by the Chief Officer.(3) Unless the service recipient, conservator, spouse or responsible relative is in agreement with the transfer, the transfer cannot occur for twenty-four (24) hours from the time of the request for approval.(4) Upon receipt of the transfer request, the Office of Forensic Services shall review the request and determine within five (5) business days whether: (a) All reasonable treatment interventions have been conducted and the service recipient should be transferred to the Forensic Services Program; or(b) All reasonable treatment interventions have not been conducted.(5) If the Office of Forensic Services concludes that all reasonable treatment interventions have not been conducted, the Office may write to the Chief Officer requesting that additional specific interventions be attempted. The Office of Forensic Services shall notify the Assistant Commissioner of this request.(6) The Chief Officer may submit additional information clarifying the treatment interventions used to manage the service recipient's behavior safely in the RMHI or, after a reasonable period of time, reapply for this transfer after the recommended interventions have been tried, evaluated, and been deemed not to have succeeded in ameliorating the conditions that triggered the original transfer request.(7) If the Office of Forensic Services determines that a service recipient should be transferred to the Forensic Services Program, a memorandum and the transfer packet shall be sent to the Assistant Commissioner notifying him or her of the recommendation to transfer.(8) If the Assistant Commissioner concludes that all reasonable treatment interventions have not been conducted, then the Assistant Commissioner shall instruct the Office of Forensic Services to write to the Chief Officer requesting that additional specific interventions be attempted.(9) If the Assistant Commissioner concludes that a service recipient should be transferred, then the Office of Forensic Services shall prepare the following documents: (a) A memo to the Commissioner from the Assistant Commissioner requesting approval for the transfer; and(b) Three authorization forms to be signed by the Director of Forensic Services, the Assistant Commissioner and the Commissioner.(10) If the Commissioner concludes that all reasonable treatment interventions have not been conducted, then the Commissioner shall instruct the Office of Forensic Services to write to the Chief Officer requesting that additional specific interventions be attempted.(11) If the Commissioner concludes that all reasonable treatment interventions have been conducted, then the Office of Forensic Services shall prepare for the Commissioner's signature the following documents: (a) A letter approving the transfer to the Chief Officer of the referring facility with a receipt of transfer notice form, an authorization letter to the service recipient, a form for the service recipient to file a complaint objecting to the transfer in Circuit Court as specified in Title 33, Chapter 7, and a signed authorization form;(b) A letter approving transfer to the Chief Officer of MTMHI with a signed authorization form; and(c) A letter to the appropriate relative or conservator with a complaint form for objecting to the transfer, sent via certified mail.(12) The following people may file a complaint in circuit court if they object to the transfer: service recipient; legal custodian, conservator, spouse or responsible relative of the service recipient. If a complaint is filed, the circuit court shall determine whether a service recipient may be transferred to a facility.
(13) Upon receipt of the transfer approval, the Chief Officer shall deliver the transfer authorization letter, the complaint form, and an acknowledgement of receipt form to the service recipient. The service recipient shall be given the opportunity to sign the acknowledgement of receipt at the time the notice is delivered. If the service recipient refuses to sign the acknowledgement of receipt, 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 Chief Officer shall keep the signed receipt for their files and place a copy in the service recipient's record.(14) When the transfer is approved, the Chief Officer shall:(a) Send written notice of the transfer to the committing court;(b) Communicate with the MTMHI Forensic Services Program Director to arrange the transfer;(c) Verify available suitable accommodations at the MTMHI Forensic Services Program by obtaining a confirmation number from MTMHI;(d) Arrange for transportation and transfer of the service recipient within two (2) business days of receiving confirmation of available suitable accommodations; and(e) Set up a teleconference between the referring physician and/or psychologist with health services provider designation and the receiving physician to discuss diagnosis and medication decisions prior to the transfer. This discussion shall be documented in the service recipient's record.(15) The MTMHI Forensic Services Program Director shall notify the referring Forensic Services Coordinator of the admission of the transferred service recipient.Tenn. Comp. R. & Regs. 0940-03-11-.02
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.