Tenn. Comp. R. & Regs. 0940-03-11-.04 - TRANSFER FROM MTMHI FORENSIC SERVICES PROGRAM TO A REGIONAL MENTAL HEALTH INSTITUTE

(1) The Commissioner may authorize the transfer of any service recipient admitted, committed, or hospitalized under T.C.A. Title 33, Chapter 5 or Chapter 7 to the MTMHI Forensic Services Program back to a regional mental health institute when:

(a) The service recipient can be more properly cared for and treated in a non-secure facility;

(b) The transfer is in the service recipient's best interest;

(c) The transfer is not contrary to the safety and welfare of the service recipient, other service recipients or the staff of the receiving facility; and

(d) The service recipient no longer requires treatment in a secure facility.

(2) If the treatment team recommends that a service recipient be transferred from the MTMHI Forensic Services Program to a Regional Mental Health Institute, the MTMHI Forensic Services Program Director shall forward the following reports to the Chief Officer of MTMHI:

(a) A certified copy of the commitment order;

(b) A copy of the most recent staff conference report;

(c) A copy of the most recent physical examination completed within the last six (6) months and updated within the past twenty-four (24) hours;

(d) A copy of the most recent risk assessment, if forensic;

(e) A report of mental assessment and evaluation for transfer if not already included in the conference report; and

(f) A copy of the notifications provided to the court, to the service recipient, and to the service recipient's nearest relative or conservator, as applicable, regarding the request for transfer.

(3) The Chief Officer of MTMHI shall review and approve the transfer request within seventy-two (72) hours of receipt and provide to the MTMHI Forensic Services Program Director a signed cover letter to the Commissioner that includes the following:

(a) Documentation of specific reasons for transfer and the service recipient's past and present behavior;

(b) Certification that the transfer is in the best interest of the service recipient; and

(c) Certification that the transfer will not be contrary to the safety and welfare of the service recipient or other service recipients and staff of the receiving facility.

(4) Within twenty-four (24) hours of receiving the cover letter signed by the Chief Officer of MTMHI, the MTMHI Forensic Services Program Director shall forward the signed cover letter to the Office of Forensic Services with the following documents:

(a) Documents listed in Rule 0940-03-11-.04(2)(a) through (f); and

(b) A copy of the signed receipt of transfer notification. If the service recipient refuses to sign the receipt of transfer notification, 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.

(5) At the time the transfer request is made to the Commissioner, the Chief Officer of MTMHI shall send a referral letter to the Chief Officer of the receiving facility along with:

(a) A copy of the documents listed in Rule 0940-03-11-.04(2)(a) through (f); and

(b) The service recipient's record.

(6) The receiving Chief Officer may challenge the transfer request to the Commissioner within ten (10) days of receiving notice of the transfer request. A physician-to- physician teleconference may be conducted as part of this review process. The written challenge to the transfer request shall include:

(a) Justification for the challenge; and

(b) An alternative Regional Mental Health Institute who has agreed to accept the transfer of the service recipient.

(7) Upon receipt of the transfer documents, the Office of Forensic Services shall:

(a) Review documents sent by the Chief Officer of MTMHI;

(b) Interview the service recipient within forty-eight (48) hours of receipt of the transfer request, excluding Saturdays, Sundays, and legal holidays;

(c) Interview staff members involved in the service recipient's treatment; and

(d) Review the clinical chart at the MTMHI Forensic Services Program.

(8) Following a review of the facts of the transfer request, the Office of Forensic Services shall prepare a report summarizing the clinical and legal information specific to the service recipient including the following:

(a) A statement that the transfer is or is not in the best interest of the service recipient;

(b) A statement that the transfer would or would not be contrary to the safety and well-being of other service recipients and staff;

(c) A description of the service recipient's current behavior;

(d) A recommendation for or against transfer with the rationale for this recommendation; and

(e) The date of the last aggressive behavior and/or attempted elopement and therapeutic intervention.

(9) If the Office of Forensic Services concurs with the recommendation for transfer, the Director of the Office of Forensic Services shall prepare a recommendation memo to the Assistant Commissioner.

(10) If the Office of Forensic Services does not concur with the recommendation for transfer, the Director of the Office of Forensic Services shall consult with the Director of the MTMHI Forensic Services Program to:

(a) Identify barriers to transfer;

(b) Develop a plan to eliminate barriers to transfer; and

(c) Establish a timeframe for reviewing progress.

(11) The Office of Forensic Services shall notify the Chief Officers of MTMHI and the receiving facility and the Assistant Commissioner of the decision to delay the transfer and the recommended plan for addressing barriers to transfer.

(12) When the barriers to transfer have been eliminated, the Director of the MTMHI Forensic Services Program shall submit an updated report to the Office of Forensic Services and the Director of Forensic Services shall complete a recommendation memorandum to the Assistant Commissioner.

(13) The Assistant Commissioner shall review the transfer request upon receipt of the recommendation memorandum.

(14) If the Assistant Commissioner approves the transfer request, the Office of Forensic Services shall draft a recommendation memorandum to the Commissioner supporting the transfer request.

(15) If the Assistant Commissioner does not concur with the recommendation of the Office of Forensic Services, the Director of the Office of Forensic Services shall:

(a) Consult with the Director of the MTMHI Forensic Services Program to identify barriers to transfer;

(b) Develop a plan to eliminate barriers to transfer; and

(c) Establish a time frame for reviewing progress.

(16) Once the barriers to transfer have been eliminated, the Director of the MTMHI Forensic Services Program shall submit an updated report to the Director of the Office of Forensic Services who shall submit the updated request to the Assistant Commissioner for review.

(17) If the Assistant Commissioner does not approve the request, consultation and planning as described in 0940-03-11-.04(16), shall continue until the Assistant Commissioner concurs with the request.

(18) When the Director of the Office of Forensic Services and the Assistant Commissioner approve the transfer request, then the Office of Forensic Services shall prepare the following materials for the Commissioner to review:

(a) A letter from the Commissioner to the Chief Officer of MTMHI approving the transfer request;

(b) A letter from the Commissioner to the Chief Officer of the receiving facility: this letter shall indicate that the transfer is to occur within thirty (30) days of the approval;

(c) Three (3) authorization forms, each with original signatures, to be signed by the Director of the Office of Forensic Services, the Assistant Commissioner and the Commissioner; these forms are attachments to the memorandum to the referring facility, the receiving facility and for Department files;

(d) A letter from the Commissioner to the service recipient at the MTMHI Forensic Services Program with a complaint form;

(e) A letter from the Commissioner to the appropriate relative or conservator of the service recipient with a complaint form; and

(f) A completed transfer cover sheet.

(19) If the Commissioner concurs with the transfer request, he or she shall complete the items specified in 0940-03-11-.04(18)(a) through (e).

(20) The Office of Forensic Services shall distribute the notifications specified in Rule 0940-03-11-.04(18)(a) through (f) after they have been completed by the Commissioner.

(21) If the Commissioner does not concur with the transfer request, the Director of the Office of Forensic Services shall consult with the Director of the MTMHI Forensic Services Program to:

(a) Identify barriers to transfer;

(b) Develop a plan to eliminate barriers to transfer; and

(c) Establish a time frame for reviewing progress.

(22) Once the barriers to transfer have been eliminated, the Director of the MTMHI Forensic Services Program shall submit an updated report to the Office of Forensic Services who shall submit this report to the Assistant Commissioner for review prior to sending it to the Commissioner. If the Commissioner does not approve the updated request, consultation and planning as described under Rule 0940-03-11-.04(21) shall continue until the Commissioner approves an updated request.

(23) After receiving notification of transfer approval, the Director of the MTMHI Forensic Services Program shall:

(a) Set up a teleconference between the referring physician and the receiving physician to discuss diagnosis and medication decisions prior to the transfer of the service recipient; this discussion shall be documented in the service recipient's record; and

(b) Arrange for transportation and the transfer of the service recipient within thirty (30) days of the receipt of the letter from the Commissioner to the Chief Officer of the receiving Regional Mental Health Institute.

(24) The Chief Officer of MTMHI shall notify the committing court of the date for transfer.

Notes

Tenn. Comp. R. & Regs. 0940-03-11-.04

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.