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Sunday, March 11, 2018

I'm Just a Bill - PTSD in Florida

Schoolhouse Rock taught a generation about the process for laws to be made or changed. I can probably still sing most of "I'm Just a Bill" which played over and over during the Saturday morning cartoon parade of my youth (sorry millennials, Xers, etc., you missed a great American institution that was Saturday cartoons). But, out of respect, I will spare you my singing. 

There has been much written about first responders and post-traumatic stress disorder. That subject became a focus of the 2018 Florida legislative session. Bob Wilson's Cluttered Desk outlined some thoughts regarding the proposed bill in late February. The legislative process is difficult to watch sometimes, and often difficult to follow. Bills are introduced and then routed through hearings in various subcommittees and committees. Those meetings are important as they provide the public with opportunities to speak on the record directly to Florida Senators and Representatives about bills, questions, criticisms, and ideas. Committee meetings are a great part of our participatory process. 

What would become "committee substitute for a committee substitute for Senate Bill 376" began its life last fall as simply Senate Bill (SB) 376. The committee substitute (CS) indicates that the bill was amended significantly along the way. The first time was in January during the hearing in the Senate Banking and Insurance Committee. It then stopped being just SB 376 and became CS/SB 376. In late February, it was heard in the Senate Appropriations Committee, was significantly amended again, and became CS/CS/SB 376. (two "CS" meaning two significant amendments). 

A similar bill was filed in the Florida House of Representatives last fall, House Bill (HB) 227. It likewise was referred to various House committees for hearing. The bill language was changed in January by the Oversight, Transparency, and Administration Subcommittee, making it CS/HB 227. In mid-February, it was changed again in the Government Operations and Technology Appropriations Subcommittee and became CS/CS/HB 227. And in late February it was changed yet again by the Governmental Accountability Committee, becoming CS/CS/CS/HB 227.

In Florida, that is a reasonably illustrative progression. Each chamber has a bill, and over time the language is changed and refined through the actions of various committees. By the time most bills finish the committee process, there is a "CS" added to the name. If the committee process in a chamber concludes with favorable votes, the bill moves to a chamber (House or Senate) "floor" and is "placed on calendar," meaning that it will be called up and discussed, and usually voted upon (sometimes it will be "tabled" or "temporarily postponed"). 

The House calendar included CS/CS/CS/HB 227 for reading on February 27, 2018 (first reading), then March 2, 2018 (second reading). The Senate calendar included CS/CS/SB 376 on February 28, 2018 (first reading), March 2, 2018 (second reading) and March 3, 2018 (third reading). Thus, the Senate concluded its work (three readings) on the bill first, and sent it to the House (in what is referred to as "messages"). On March 5, 2018, the House took the matter up "on the floor" and voted to "table" CS/CS/CS/HB 227 and to instead vote on CS/CS/SB 376, passing it. With both chambers thus passing the bill in its final form (CS/CS/SB 376), it was then "ordered enrolled" meaning that it would be sent to the Governor for his consideration (a process of "checks and balances" most of us will remember from high school perhaps). 

And, with all of the debate and discussion of the proposal to make Florida a mental/mental state, the bill will be presented to the Governor at some point in the coming days. The Governor is presented with many bills each legislative session, and may either: veto the bill, sign the law, or allow the bill to become law without a signature. For those of us who only remember the discussion of the U.S. Presidential veto from high school, Florida is distinct in this manner. There is no "allow it to become law without a signature" in our federal government. An interesting distinction and trivia. 

So, where does this long (the House and Senate bills were filed last October) process leave Florida workers' compensation? Well, the bill will not change the Florida workers' compensation law, Chapter 440, F.S. The bill instead amends Section 112.1815, F.S. That statute creates "special provisions for employment-related accidents and injuries." That law already defines "first responder," and deals with topics including smallpox, the effects of entitlement to social security, and the burden of proof for occupational disease. All of its "special provisions" are for "first responders."

The enrolled (meaning it will be sent to the Governor) bill, CS/CS/SB 376, says that "posttraumatic (sic) stress disorder (PTSD), as described in the Diagnostic and Statistical Manual of Mental Disorders" (a resource adopted by and used by mental health professionals) when a first responder suffers from it, "is a compensable occupational disease" for the purposes of workers' compensation in Florida, so long as some criteria are met. 

First, the PTSD must result from the "first responder acting within the course of his or her employment as provided in s. 440.091." Second, PTSD must be diagnosed "by a licensed psychiatrist who is an authorized treating physician as provided in chapter 440." Third, the PTSD "must be demonstrated by clear and convincing medical evidence." And, fourth, PTSD must be due to "one of the following events":

a. Seeing for oneself a deceased minor; 
b. Directly witnessing the death of a minor; 
c. Directly witnessing an injury to a minor who subsequently died before or upon arrival at a hospital emergency department; 
d. Participating in the physical treatment of an injured minor who subsequently died before or upon arrival at a hospital emergency department; 
e. Manually transporting an injured minor who subsequently 48 died before or upon arrival at a hospital emergency department; 
f. Seeing for oneself a decedent whose death involved grievous bodily harm of a nature that shocks the conscience; 
g. Directly witnessing a death, including suicide, that involved grievous bodily harm of a nature that shocks the conscience; 
h. Directly witnessing a homicide regardless of whether the homicide was criminal or excusable, including murder, mass killing as defined in 28 U.S.C. s. 530C, manslaughter, self-defense, misadventure, and negligence;
i. Directly witnessing an injury, including an attempted suicide, to a person who subsequently died before or upon arrival at a hospital emergency department if the person was injured by grievous bodily harm of a nature that shocks the conscience; 
j. Participating in the physical treatment of an injury, including an attempted suicide, to a person who subsequently died before or upon arrival at a hospital emergency department if the person was injured by grievous bodily harm of a nature that shocks the conscience; or 
k. Manually transporting a person who was injured, including by attempted suicide, and subsequently died before or upon arrival at a hospital emergency department if the person was injured by grievous bodily harm of a nature that shocks the conscience.

Those who have read Bob Wilson's Cluttered Desk and its analysis of an earlier version of the bill will likely conclude that the bill that has been enrolled (meaning it will be sent to the Governor) is notably different from the bill version analyzed by Mr. Wilson. And, that evolution of bill language, as discussed above, is a common part and parcel of the legislative process. 

There may be those who disagree with this change to Florida law, and as likely those who agree. It is possible that some will say CS/CS/SB 376 goes "too far" and others may lament "it doesn't go far enough." But, for everyone, the introduction of an idea and its evolution in the Florida legislative process should be of interest.

This bill aptly demonstrates the path and process of bills that travel the "filed" to "enrolled" journey in Florida. It illustrates the committee process, amendment process, and one possible conclusion (a great many bills start that journey, but fail somewhere along the path). And now, the waiting begins as the Governor considers the many 2018 enrolled bills. News sources report that the Governor will sign the bill, so that seems likely.