SESSION WATCH
THE BILL ITSELF

CS/CS/HB 47

Specific Medical Diagnoses in Child Protective Investigations

VERSION H 47 er · BACK TO THE SUMMARY · OFFICIAL RECORD

underlined language is being added; struck language is being deleted. Line numbers are the Legislature's own — the same ones amendments cite.

2 An act relating to specific medical diagnoses in child
3 protective investigations; amending s. 39.301, F.S.;
4 providing an exception to the requirement that the
5 Department of Children and Families immediately
6 forward certain allegations to a law enforcement
7 agency; requiring such allegations to be immediately
8 forwarded to a law enforcement agency upon completion
9 of the department's investigation; requiring a child
10 protective investigator to inform the subject of an
11 investigation of a certain duty; requiring the
12 department to request medical records of certain
13 children from certain licensed health care
14 professionals; conforming a cross-reference; amending
15 s. 39.303, F.S.; requiring Child Protection Teams to
16 consult with a licensed physician or advanced practice
17 registered nurse with certain experience when
18 evaluating certain reports; conforming cross-
19 references; amending s. 39.304, F.S.; authorizing a
20 parent or legal custodian of a child who is the
21 subject of a protective investigation or shelter order
22 to request specified medical examinations of the child
23 within a specified timeframe; requiring that certain
24 medical examinations be paid for by the parent or
25 legal custodian making the request or as otherwise
26 covered by insurance; requiring the physician or
27 advanced practice registered nurse who performed
28 certain medical examinations to submit a written
29 report to the department and certain persons within a
30 specified timeframe; requiring the department to
31 immediately convene a case staffing with specified
32 persons under certain circumstances; amending s.
33 456.057, F.S.; requiring certain records be provided
34 to the department within a specified timeframe;
35 providing an effective date.
37 Be It Enacted by the Legislature of the State of Florida:
39 Section 1. Paragraph (a) of subsection (2), paragraph (a)
40 of subsection (5), paragraph (a) of subsection (9), and
41 paragraph (c) of subsection (14) of section 39.301, Florida
42 Statutes, are amended to read:
43 39.301 Initiation of protective investigations.—
44 (2)(a) The department shall immediately forward
45 allegations of criminal conduct to the municipal or county law
46 enforcement agency of the municipality or county in which the
47 alleged conduct has occurred. However, the department may delay
48 forwarding allegations of criminal conduct to the appropriate
49 law enforcement agency if the parent or legal custodian:
50 1. Has alleged that the child has a preexisting medical
51 diagnosis specified in s. 39.303(4); or
52 2. Is requesting that the child have a medical examination
53 under s. 39.304(1)(c).
55 Allegations of criminal conduct which are not immediately
56 forwarded to the law enforcement agency pursuant to subparagraph
57 1. or subparagraph 2. must be immediately forwarded to the law
58 enforcement agency upon completion of the investigation under
59 this part if criminal conduct is still alleged.
60 (5)(a) Upon commencing an investigation under this part,
61 the child protective investigator shall inform any subject of
62 the investigation of the following:
63 1. The names of the investigators and identifying
64 credentials from the department.
65 2. The purpose of the investigation.
66 3. The right to obtain his or her own attorney and ways
67 that the information provided by the subject may be used.
68 4. The possible outcomes and services of the department's
69 response.
70 5. The right of the parent or legal custodian to be
71 engaged to the fullest extent possible in determining the nature
72 of the allegation and the nature of any identified problem and
73 the remedy.
74 6. The duty of the parent or legal custodian to report any
75 change in the residence or location of the child to the
76 investigator and that the duty to report continues until the
77 investigation is closed.
78 7. The duty of the parent or legal custodian to
79 immediately report any preexisting medical diagnosis for the
80 child specified in s. 39.303(4) and to provide the name and
81 contact information of the licensed health care professional who
82 made such diagnosis or treated the child for the diagnosed
83 condition to the department within 10 days after being informed
84 of such duty.
85 (9)(a) For each report received from the central abuse
86 hotline and accepted for investigation, the department shall
87 perform the following child protective investigation activities
88 to determine child safety:
89 1. Conduct a review of all relevant, available information
90 specific to the child, family, and alleged maltreatment; family
91 child welfare history; local, state, and federal criminal
92 records checks; and requests for law enforcement assistance
93 provided by the abuse hotline. Based on a review of available
94 information, including the allegations in the current report, a
95 determination must shall be made as to whether immediate
96 consultation should occur with law enforcement, the Child
97 Protection Team, a domestic violence shelter or advocate, or a
98 substance abuse or mental health professional. Such
99 consultations should include discussion as to whether a joint
100 response is necessary and feasible. A determination must shall
101 be made as to whether the person making the report should be
102 contacted before the face-to-face interviews with the child and
103 family members.
104 2. Conduct face-to-face interviews with the child; other
105 siblings, if any; and the parents, legal custodians, or
106 caregivers.
107 3. Assess the child's residence, including a determination
108 of the composition of the family and household, including the
109 name, address, date of birth, social security number, sex, and
110 race of each child named in the report; any siblings or other
111 children in the same household or in the care of the same
112 adults; the parents, legal custodians, or caregivers; and any
113 other adults in the same household.
114 4. Determine whether there is any indication that any
115 child in the family or household has been abused, abandoned, or
116 neglected; the nature and extent of present or prior injuries,
117 abuse, or neglect, and any evidence thereof; and a determination
118 as to the person or persons apparently responsible for the
119 abuse, abandonment, or neglect, including the name, address,
120 date of birth, social security number, sex, and race of each
121 such person.
122 5. Complete assessment of immediate child safety for each
123 child based on available records, interviews, and observations
124 with all persons named in subparagraph 2. and appropriate
125 collateral contacts, which may include other professionals, and
126 continually assess the child's safety throughout the
127 investigation. The department's child protection investigators
128 are hereby designated a criminal justice agency for the purpose
129 of accessing criminal justice information to be used for
130 enforcing this state's laws concerning the crimes of child
131 abuse, abandonment, and neglect. This information must shall be
132 used solely for purposes supporting the detection, apprehension,
133 prosecution, pretrial release, posttrial release, or
134 rehabilitation of criminal offenders or persons accused of the
135 crimes of child abuse, abandonment, or neglect and may not be
136 further disseminated or used for any other purpose.
137 6. For a child who has a preexisting medical diagnosis
138 specified in s. 39.303(4), as reported by the parent or legal
139 custodian of the child, request the relevant medical records
140 from the licensed health care professional who diagnosed or
141 treated the child for such medical diagnosis.
142 7.6. Document the present and impending dangers to each
143 child based on the identification of inadequate protective
144 capacity through utilization of a standardized safety assessment
145 instrument. If present or impending danger is identified, the
146 child protective investigator must implement a safety plan or
147 take the child into custody. If present danger is identified and
148 the child is not removed, the child protective investigator must
149 shall create and implement a safety plan before leaving the home
150 or the location where there is present danger. If impending
151 danger is identified, the child protective investigator must
152 shall create and implement a safety plan as soon as necessary to
153 protect the safety of the child. The child protective
154 investigator may modify the safety plan if he or she identifies
155 additional impending danger.
156 a. If the child protective investigator implements a
157 safety plan, the plan must be specific, sufficient, feasible,
158 and sustainable in response to the realities of the present or
159 impending danger. A safety plan may be an in-home plan or an
160 out-of-home plan, or a combination of both. A safety plan may
161 include tasks or responsibilities for a parent, caregiver, or
162 legal custodian. However, a safety plan may not rely on
163 promissory commitments by the parent, caregiver, or legal
164 custodian who is currently not able to protect the child or on
165 services that are not available or will not result in the safety
166 of the child. A safety plan may not be implemented if for any
167 reason the parents, guardian, or legal custodian lacks the
168 capacity or ability to comply with the plan. If the department
169 is not able to develop a plan that is specific, sufficient,
170 feasible, and sustainable, the department must shall file a
171 shelter petition. A child protective investigator must shall
172 implement separate safety plans for the perpetrator of domestic
173 violence, if the investigator, using reasonable efforts, can
174 locate the perpetrator to implement a safety plan, and for the
175 parent who is a victim of domestic violence as defined in s.
176 741.28. Reasonable efforts to locate a perpetrator include, but
177 are not limited to, a diligent search pursuant to the same
178 requirements as in s. 39.503. If the perpetrator of domestic
179 violence is not the parent, guardian, or legal custodian of any
180 child in the home and if the department does not intend to file
181 a shelter petition or dependency petition that will assert
182 allegations against the perpetrator as a parent of a child in
183 the home, the child protective investigator must shall seek
184 issuance of an injunction authorized by s. 39.504 to implement a
185 safety plan for the perpetrator and impose any other conditions
186 to protect the child. The safety plan for the parent who is a
187 victim of domestic violence may not be shared with the
188 perpetrator. If any party to a safety plan fails to comply with
189 the safety plan resulting in the child being unsafe, the
190 department must shall file a shelter petition.
191 b. The child protective investigator shall collaborate
192 with the community-based care lead agency in the development of
193 the safety plan as necessary to ensure that the safety plan is
194 specific, sufficient, feasible, and sustainable. The child
195 protective investigator shall identify services necessary for
196 the successful implementation of the safety plan. The child
197 protective investigator and the community-based care lead agency
198 shall mobilize service resources to assist all parties in
199 complying with the safety plan. The community-based care lead
200 agency shall prioritize safety plan services to families who
201 have multiple risk factors, including, but not limited to, two
202 or more of the following:
203 (I) The parent or legal custodian is of young age;
204 (II) The parent or legal custodian, or an adult currently
205 living in or frequently visiting the home, has a history of
206 substance abuse, mental illness, or domestic violence;
207 (III) The parent or legal custodian, or an adult currently
208 living in or frequently visiting the home, has been previously
209 found to have physically or sexually abused a child;
210 (IV) The parent or legal custodian, or an adult currently
211 living in or frequently visiting the home, has been the subject
212 of multiple allegations by reputable reports of abuse or
213 neglect;
214 (V) The child is physically or developmentally disabled;
215 or
216 (VI) The child is 3 years of age or younger.
217 c. The child protective investigator shall monitor the
218 implementation of the plan to ensure the child's safety until
219 the case is transferred to the lead agency at which time the
220 lead agency shall monitor the implementation.
221 d. The department may file a petition for shelter or
222 dependency without a new child protective investigation or the
223 concurrence of the child protective investigator if the child is
224 unsafe but for the use of a safety plan and the parent or
225 caregiver has not sufficiently increased protective capacities
226 within 90 days after the transfer of the safety plan to the lead
227 agency.
228 (14)
229 (c) The department, in consultation with the judiciary,
230 shall adopt by rule:
231 1. Criteria that are factors requiring that the department
232 take the child into custody, petition the court as provided in
233 this chapter, or, if the child is not taken into custody or a
234 petition is not filed with the court, conduct an administrative
235 review. Such factors must include, but are not limited to,
236 noncompliance with a safety plan or the case plan developed by
237 the department, and the family under this chapter, and prior
238 abuse reports with findings that involve the child, the child's
239 sibling, or the child's caregiver.
240 2. Requirements that if after an administrative review the
241 department determines not to take the child into custody or
242 petition the court, the department must shall document the
243 reason for its decision in writing and include it in the
244 investigative file. For all cases that were accepted by the
245 local law enforcement agency for criminal investigation pursuant
246 to subsection (2), the department must include in the file
247 written documentation that the administrative review included
248 input from law enforcement. In addition, for all cases that must
249 be referred to Child Protection Teams pursuant to s. 39.303(5)
250 and (6) s. 39.303(4) and (5), the file must include written
251 documentation that the administrative review included the
252 results of the team's evaluation.
253 Section 2. Subsections (4) through (10) of section 39.303,
254 Florida Statutes, are renumbered as subsections (5) through
255 (11), respectively, present subsections (5) and (6) of that
256 section are amended, and a new subsection (4) is added to that
257 section, to read:
258 39.303 Child Protection Teams and sexual abuse treatment
259 programs; services; eligible cases.—
260 (4) A Child Protection Team shall consult with a physician
261 licensed under chapter 458 or chapter 459 or an advanced
262 practice registered nurse licensed under chapter 464 who has
263 experience treating children with the medical conditions
264 specified in this subsection when evaluating a child with a
265 reported preexisting medical diagnosis of any of the following:
266 (a) Rickets.
267 (b) Ehlers-Danlos syndrome.
268 (c) Osteogenesis imperfecta.
269 (d) Vitamin D deficiency.
270 (6)(5) All abuse and neglect cases transmitted for
271 investigation to a circuit by the hotline must be simultaneously
272 transmitted to the Child Protection Team for review. For the
273 purpose of determining whether a face-to-face medical evaluation
274 by a Child Protection Team is necessary, all cases transmitted
275 to the Child Protection Team which meet the criteria in
276 subsection (5) (4) must be timely reviewed by:
277 (a) A physician licensed under chapter 458 or chapter 459
278 who holds board certification in pediatrics and is a member of a
279 Child Protection Team;
280 (b) A physician licensed under chapter 458 or chapter 459
281 who holds board certification in a specialty other than
282 pediatrics, who may complete the review only when working under
283 the direction of the Child Protection Team medical director or a
284 physician licensed under chapter 458 or chapter 459 who holds
285 board certification in pediatrics and is a member of a Child
286 Protection Team;
287 (c) An advanced practice registered nurse licensed under
288 chapter 464 who has a specialty in pediatrics or family medicine
289 and is a member of a Child Protection Team;
290 (d) A physician assistant licensed under chapter 458 or
291 chapter 459, who may complete the review only when working under
292 the supervision of the Child Protection Team medical director or
293 a physician licensed under chapter 458 or chapter 459 who holds
294 board certification in pediatrics and is a member of a Child
295 Protection Team; or
296 (e) A registered nurse licensed under chapter 464, who may
297 complete the review only when working under the direct
298 supervision of the Child Protection Team medical director or a
299 physician licensed under chapter 458 or chapter 459 who holds
300 board certification in pediatrics and is a member of a Child
301 Protection Team.
302 (7)(6) A face-to-face medical evaluation by a Child
303 Protection Team is not necessary when:
304 (a) The child was examined for the alleged abuse or
305 neglect by a physician who is not a member of the Child
306 Protection Team, and a consultation between the Child Protection
307 Team medical director or a Child Protection Team board-certified
308 pediatrician, advanced practice registered nurse, physician
309 assistant working under the supervision of a Child Protection
310 Team medical director or a Child Protection Team board-certified
311 pediatrician, or registered nurse working under the direct
312 supervision of a Child Protection Team medical director or a
313 Child Protection Team board-certified pediatrician, and the
314 examining physician concludes that a further medical evaluation
315 is unnecessary;
316 (b) The child protective investigator, with supervisory
317 approval, has determined, after conducting a child safety
318 assessment, that there are no indications of injuries as
319 described in paragraphs (5)(a)-(h) (4)(a)-(h) as reported; or
320 (c) The Child Protection Team medical director or a Child
321 Protection Team board-certified pediatrician, as authorized in
322 subsection (6) (5), determines that a medical evaluation is not
323 required.
325 Notwithstanding paragraphs (a), (b), and (c), a Child Protection
326 Team medical director or a Child Protection Team pediatrician,
327 as authorized in subsection (6) (5), may determine that a face-
328 to-face medical evaluation is necessary.
329 Section 3. Paragraphs (c), (d), and (e) are added to
330 subsection (1) of section 39.304, Florida Statutes, to read:
331 39.304 Photographs, medical examinations, X rays, and
332 medical treatment of abused, abandoned, or neglected child.—
333 (1)
334 (c) If a medical examination is performed on a child under
335 paragraph (b), other than a medical examination for purposes of
336 determining whether a child has been sexually abused, the parent
337 or legal custodian of the child who is the subject of a
338 protective investigation or shelter order may request of the
339 department, no later than 10 days after such medical
340 examination, that the child be examined by:
341 1. A Child Protection Team if the medical examination
342 under paragraph (b) was not performed by a Child Protection
343 Team;
344 2. A physician licensed under chapter 458 or chapter 459
345 or an advanced practice registered nurse licensed under chapter
346 464 of the parent's or legal custodian's choosing who routinely
347 provides medical care to pediatric patients, if the medical
348 examination under paragraph (b) was performed by a Child
349 Protection Team, for the purpose of obtaining a second opinion
350 on diagnosis or treatment; or
351 3. A physician licensed under chapter 458 or chapter 459
352 or an advanced practice registered nurse licensed under chapter
353 464 of the parent's or legal custodian's choosing who routinely
354 provides diagnosis of and medical care to pediatric patients for
355 the conditions specified in s. 39.303(4) to consider a
356 differential diagnosis.
358 The cost of a medical examination under subparagraph 2. or
359 subparagraph 3. must be borne by the parent or legal custodian,
360 including through his or her health care coverage, if
361 applicable.
362 (d) Notwithstanding s. 39.202(6), for all medical
363 examinations performed pursuant to paragraph (c), the physician
364 or advanced practice registered nurse must submit within 10 days
365 after the medical examination a written report that details the
366 findings and conclusions of the medical examination to the
367 department and the parent or legal custodian.
368 (e) If the findings and conclusions of the medical
369 examination conducted under paragraph (b) and the medical
370 examination conducted under paragraph (c) differ, the department
371 must immediately convene a case staffing to reach a consensus
372 regarding the differences in the medical opinions. The case
373 staffing must include the child protective investigator, the
374 investigator's supervisor, legal staff of the department,
375 representatives from a Child Protection Team, and the community-
376 based care lead agency. If possible, the case staffing must also
377 include any health care practitioners who previously treated the
378 child, any health care practitioners who are currently treating
379 the child, and the physician or advanced practice registered
380 nurse who conducted the medical examination under paragraph (c).
381 Section 4. Paragraph (a) of subsection (7) of section
382 456.057, Florida Statutes, is amended to read:
383 456.057 Ownership and control of patient records; report
384 or copies of records to be furnished; disclosure of
385 information.—
386 (7)(a) Except as otherwise provided in this section and in
387 s. 440.13(4)(c), such records may not be furnished to, and the
388 medical condition of a patient may not be discussed with, any
389 person other than the patient, the patient's legal
390 representative, or other health care practitioners and providers
391 involved in the patient's care or treatment, except upon written
392 authorization from the patient. However, such records may be
393 furnished without written authorization under the following
394 circumstances:
395 1. To any person, firm, or corporation that has procured
396 or furnished such care or treatment with the patient's consent.
397 2. When compulsory physical examination is made pursuant
398 to Rule 1.360, Florida Rules of Civil Procedure, in which case
399 copies of the medical records shall be furnished to both the
400 defendant and the plaintiff.
401 3. In any civil or criminal action, unless otherwise
402 prohibited by law, upon the issuance of a subpoena from a court
403 of competent jurisdiction and proper notice to the patient or
404 the patient's legal representative by the party seeking such
405 records.
406 4. For statistical and scientific research, provided the
407 information is abstracted in such a way as to protect the
408 identity of the patient or provided written permission is
409 received from the patient or the patient's legal representative.
410 5. To a regional poison control center for purposes of
411 treating a poison episode under evaluation, case management of
412 poison cases, or compliance with data collection and reporting
413 requirements of s. 395.1027 and the professional organization
414 that certifies poison control centers in accordance with federal
415 law.
416 6. To the Department of Children and Families, its agent,
417 or its contracted entity, for the purpose of investigations of
418 or services for cases of abuse, neglect, or exploitation of
419 children or vulnerable adults. Records requested by the
420 Department of Children and Families pursuant to s. 39.301(9)(a)
421 must be furnished to the Department of Children and Families
422 within 14 days after such request.
423 Section 5. This act shall take effect July 1, 2026.