Current through Register Vol. 54, No. 44, November 2, 2024
The following is the manual of rights for persons in
treatment:
Article I: The Right to
Communicate
Statement of Principle
4. Right to Have Visitors
5. Right to Send and Receive
Letters
6. Right to Use
Telephones
Article II: The Right of Religious
Freedom
Statement of Principle
1. Right to Refuse Medication
2. Right to Diets Based on Religious or
Ethical Consideration
3. Right to
Abstain from Religious Practices
Article III:The Right to Handle Your Personal
Affairs
Article IV:The Right to a Humane Physical and
Psychological Environment
Article V: The Right to Treatment
Statement of Principle
1. Individualized Treatment Plan
Article VI: Permissible, Restricted and
Prohibited Treatment Procedures
Statement of Principle
1. Permissible Procedures
Article VII: Grievance and Appeal
Procedures
Statement of Principle
ARTICLE I
THE RIGHT TO COMMUNICATE
Statement of Principle.
(a) Every patient has the right and shall be
encouraged to communicate freely and privately with others within the facility
and in the community at large, as described below. This is based upon the firm
belief that meaningful communications are essential to a successful course of
treatment. These rights may be suspended or restricted for a limited period by
the treating physician only when reasonable cause exists to believe that
failure to suspend communications will result in a substantial risk of serious
and immediate harm to the patient or others, or that a crime is being
committed. The physician shall fully explain any suspensions or restrictions of
these rights to the patient and document the reasons for the restriction in the
patient's record. Suspension or restrictions shall be reviewed and documented
every 48 hours until the risk of serious and immediate harm is
reduced.
(b) Every patient shall
have the right to make complaints and offer suggestions to the director, or his
designee, regarding the operation of the facility, and may meet with other
patients to discuss their concerns with facility administrators. Complaints and
suggestions shall be heard and decided promptly.
1. Right to Information.
(a) Every patient has the right to be
informed of his rights and responsibilities while in treatment, and those house
rules and regulations of the facility which affect his treatment.
(b) Every patient has the right to be
informed of diagnostic and treatment procedures, their risks and their costs,
that are available to him and which would aid in his recovery from mental
illness. Patients have the right to be informed of the reasons and factors
involved in recommending a procedure of choice.
(c) Every patient has the right to be
informed of the nature of material about to be released to others (or obtained)
when he is requested to sign a release of information.
2. Right to Assistance.
(a) Every patient shall have the right to the
assistance of an independent person not a member of his treatment team to
resolve a problem raised by the patient.
(b) Each non-State facility shall designate
one or more persons either on a volunteer or staff basis as needed to help
patients in this manner.
(c) State
facilities shall designate one or more staff to aid patients, and these persons
shall be accessible during regular working hours.
(d) Every State facility shall advise and
educate all patients about the availability and services of this
program.
(e) These persons will be
responsible for assisting or supporting the patient in meeting with the
appropriate person to discuss the problem and possible solution. They shall
maintain a confidential file of requests for service and subsequent actions
taken. The file shall be open to review only by the facility director or the
patient's Attorney and shall be filed with the patient's clinical record upon
discharge. They have no authority to directly resolve problems but may report
his or her findings directly to the facility director.
3. Right to an Attorney.
(a) Every patient has the right to retain an
attorney of his choice to assist the patient in asserting his rights to
treatment or release or to aid the patient in any other matter.
(b) The facility will provide patients with
referral information and other non-monetary assistance to enable patients to
implement this right. The names, addresses and telephone numbers of legal
services and other available advocates in this area shall be given to all
patients.
(c) Every patient has the
right to see or telephone his attorney in private at any reasonable time,
regardless of visiting hours.
4. Right to Have Visitors.
(a) Every patient has the right to receive
visitors of his own choice daily, within established visiting hours, in a
setting of reasonable privacy conducive to free and open conversation unless a
visitor or visitors are determined to seriously interfere with a patient's
treatment or welfare.
(b)
Established visiting hours shall attempt to meet the needs of individual
patients and visitors, and may be waived to the extent feasible to accommodate
special circumstances or the needs of individual patients.
5. Right to Send and Receive Letters.
(a) Every patient has the right to send
unopened mail. Reasonable amounts of such mail shall be stamped free of charge
if sufficient personal funds are not available.
(b) Writing materials shall be made available
to patients on a daily basis and an opportunity provided for writing letters
and other communications. Reasonable assistance shall be provided upon request,
if feasible.
(c) Incoming mail may
be opened only when there is reason to suspect it contains contraband, and in
the presence of the patient unless dangerous or infeasible in the light of the
patient's condition. Contraband is specific property, the possession or use of
which is illegal or entails a substantial threat to the health and welfare of
the patient or the hospital community.
(d) Whenever mail is opened on suspicion of
contraband, an identification of the person opening the mail, a statement of
the facts constituting good cause, and the results of the opening including
disposition shall be noted in the patient's record.
(e) A patient's mail, whether incoming or
outgoing, shall not be read under any circumstances, unless at the patient's
request.
6. Right to Use
Telephones.
(a) Every patient has the right to
make telephone calls at his own expense, at reasonable times, using telephones
designated for patient or public use. The facility shall take steps to provide
sufficient telephones.
(b) In cases
of personal emergency, when alternative methods of communication are
impractical, every patient shall have the right to make reasonable local and
long distance phone calls, free of charge. These calls shall be subject to
reimbursement if the patient has sufficient funds to pay for the call. The
director of the facility, or his delegate, shall determine what constitutes
personal emergency.
ARTICLE II THE RIGHT TO RELIGIOUS FREEDOM
Statement of Principle.
Every patient has the right to follow and practice his
religion. Substantiated ethical convictions held independently of a belief in
any religion shall be accorded the same respect as religious belief. The
facilty shall provide reasonable assistance to enable a patient to effect this
right.
The exercise of these rights may be limited only if it
poses a serious threat to the freedom or welfare of others, or a serious danger
to the patient.
1. Right to Refuse
Medication.
Any patient who holds a substantiated belief in the power
of spiritual healing shall not be compelled to take medication, provided the
patient is intellectually capable of understanding the impact of such refusal
and of deciding to refuse medication.
2. Right to Diets Based on Religious Considerations.
The patient's right to independently comply with his or
her dietary regimen shall not be interfered with by the facility unless
unfeasible or unless there is serious danger to a person's health.
3. Right to Abstain from
Religious Practices.
No patient shall be required to be pressured directly or
indirectly to participate in religious practices. No patient shall be compelled
to accept visitation from a clergyman or minister of any
religion.
ARTICLE III THE RIGHT TO HANDLE YOUR PERSONAL AFFAIRS
Statement of Principle.
Every patient retains all civil rights not specifically
curtailed by an order of a court or other body empowered to take such action.
(a) Every patient has the right to
handle his personal affairs. Admission or commitment to a mental health
facility does not by itself, prevent a patient from holding a driver's license
or professional license, from marrying or obtaining a divorce, from voting or
writing a will, or exercising other civil and personal rights; nor is the
patient guaranteed the ability to exercise any of these rights.
(b) Every patient has the right to purchase,
keep, and use personal possessions. This right may be limited only when the
possession or use of specific property is illegal or creates a substantial
threat to the health or welfare of the patient or others. The reasons for
imposing any limitations on the exercise of this right and the scope of such
limitation shall be clearly explained to the patient and placed in the
patient's record.
(c) Every patient
has the right to sell or retain any product or crop he makes, or grows on
facility property. Money received from these activities shall not be used to
pay the costs of any patient's care and treatment.
(d) A patient shall not be deemed incompetent
to manage his own affairs solely by reason of admission or commitment to a
mental health facility.
A court finding of incompetency may not be extended
beyond the specific scope of the court order.
ARTICLE IV RIGHT TO A HUMANE PHYSICAL AND PSYCHOLOGICAL
ENVIRONMENT
Statement of Principle.
Every patient has the right to reside and be treated in a
setting which preserves and promotes his physical and psychological dignity.
(a) Every patient has the right to be
treated humanely and with consideration by all staff members. Any grossly
negligent or intentional conduct of staff which causes or may cause emotional
or physical harm to a patient is a violation of this right.
(b) Every patient has the right to assistance
in developing a physical appearance which promotes a positive self image. This
includes the following:
(1) The right to keep
and wear his own clothing, unless there are reasonable grounds to believe such
clothing or specific items constitute a substantial threat to the health or
safety of the patient or others.
(2) Clothing provided by the facility shall
be neat, clean, appropriate to the season and to the extent possible,
consistent with the patient's personal preference. This clothing shall enable
the patient to make a customary appearance within the community.
(3) The right to purchase, keep, and use
customary cosmetic, hygiene, and grooming articles or services unless there are
reasonable grounds to believe specific articles constitute a substantial threat
to the health or safety of the patient or others.
(4) Basic customary cosmetic, hygiene, and
grooming articles or services shall be provided by the facility for patients
who need them but cannot afford them. Patients shall be given reasonable
assistance as needed in utilizing cosmetic, hygiene, and grooming articles and
services.
(c) Every
residential patient shall be furnished with a comfortable bed and bedding,
adequate change of linen, a closet or locker for personal belongings, and a
bedside cabinet. Every patient, at his or her own risk, shall be allowed to
keep and display appropriate personal belongings and to add personal touches to
his room or living area.
(d) Every
patient has the right to a nutritionally adequate diet and every patient has
the right to eat or to be fed under supervision, in the dining room or area in
the relaxed atmosphere, and to use normal eating implements, unless
contra-indicated by the patient's conduct or course of treatment.
(e) Every patient has the right to bathroom
facilities which provide privacy for personal hygiene and meet Departmental
standards for health, safety, and cleanliness.
(f) Every patient has the right to
therapeutic and daily living activities held in settings that approximate
noninstitutional living. Dining, recreational, vocational, and other activities
shall where possible and appropriate be conducted on a basis which provides
interaction between male and female patients.
ARTICLE V RIGHT TO TREATMENT
Statement of Principle.
Every patient has the right to receive treatment designed
to aid and promote his recovery from mental illness. This treatment shall,
whenever possible, be in or near the patient's home community, and shall be in
the least restrictive setting available to provide adequate treatment or to
meet the conditions of security imposed by a court.
1. Individual Treatment Plan.
(a) Every patient has the right to an
individualized treatment plan, appropriate to his needs, setting forth the
objectives, goals, activities, experiences, and therapies designed to promote
recovery.
(b) The plan shall be
developed within 72 hours of admission or commitment. It shall be revised
whenever necessary and reviewed at least every 30 days.
(c) Every patient has the right to
participate to the extent feasible in the development of his treatment plan.
The plan shall be written in terms understandable by lay persons and shall be
explained to the patient. A copy of the treatment plan shall be made available
for the patient's review.
2. Discharge.
Every patient has the right to be discharged as soon as
care and treatment is no longer necessary. Every patient has the right to all
of the available treatment modalties appropriate to his or her needs which
promote recovery and discharge. Treatment shall also include the appropriate
post-discharge rehabilitative services available in the
community.
ARTICLE VI PERMISSIBLE SPECIALIZED AND PROHIBITED
TREATMENT PROCEDURES
Statement of Principle.
Every patient shall only receive approved treatment
procedures in accordance with Departmental regulations. This treatment shall be
described in his individual treatment plan and shall be explained to the
patient.
1. Permissible Procedures.
(a) All patients may in an emergency, be
required to accept the minimal sufficient diagnostic procedures and treatment
necessary to alleviate the emergency.
(b) Patients committed pursuant to sections
303, 304 or 305 of the act (50 P. S. §§
4303,
4304, and
4305), may also be required
to accept routine medical, psychiatric, psychological, and educational programs
conforming to departmental regulations and the patient's individualized
treatment plan.
(c) Any patient
committed for examination by court may be required to accept the minimal
diagnostic procedures necessary to determine the patient's mental
condition.
(d) Any patient in
treatment on a voluntary basis may agree to participate in any and all approved
treatment methods as described in his individualized treatment plan. Any
voluntary patient may also refuse to participate in any aspect of his
individualized treatment plan and may request a review of the proposed
treatment. Refusal to accept a reviewed and approved treatment may be cause for
discharge.
2. Specialized
Procedures.
(a) No patient shall be subject to
the withholding of privileges, nor to any system of rewards, except as part of
an individualized treatment plan.
(b) Electro-convulsive or other therapy,
experimental treatments involving any risk to the patient, or aversion therapy
shall not be prescribed unless:
(1) The
patient's treatment team has documented in the patient's record that all
reasonable and less intensive treatment modalities have been considered; that
the treatment represents the most effective therapy for the patient at that
time; and that the patient has been given a full explanation of the nature and
duration of the proposed treatment and why the treatment team is recommending
the treatment; and that the patient has been told that he or she has the right
to accept or refuse the proposed treatment and that if he consents, has the
right to revoke his consent for any reason at any time prior to or between
treatments.
(2) The treatment was
recommended by qualified staff members trained and experienced in the treatment
procedure and has been approved by the facility administrator if an M.D. or, if
not, by the clinical director after review by the appropriate
committee.
(3) The patient has
given written informed consent to the specific proposed treatment. In the
alternative, oral informed consent is sufficient where that consent is
witnessed by two persons not part of the patient's treatment team. In either
case, such consent shall be limited to a specified number of maximum treatments
over a specific period of time and shall be revocable at any time before or
between treatments. Such withdrawal of consent may be immediately
effective.
(4) If a patient's
treatment team determines that the patient could benefit from one of those
specified treatments but also believes that the patient does not have the
capacity to give informed consent to the treatment, a court order shall be
obtained authorizing the recommended treatment before such treatment may be
administered to the patient.
(c) No patient shall be subject to chemical,
physical, or psychological restraints, including seclusion, other than in
accordance to the Department's regulations applicable to State Mental Health
Facilities or, in case of community facilities, the policy and procedures for
seclusion and restraint approved by its medical staff and governing body. A
copy of the applicable regulations shall be made available to patients upon
request.
(d) No patient shall be
the subject of any research, unless conducted in strict compliance with Federal
regulations on the protection of human subjects. Patients considered for
research approved by the facility shall receive and understand a full
explanation of the nature of the research, the expected benefit, and the
potential risk involved. Copies of the Federal regulations shall be made
available to patients involved in, or considering becoming involved in,
research or their advocates. Patient research conducted in State facilities or
funded by State monies requires prior approval of the Deputy Secretary of
Mental Health.
3.
Prohibited Procedures.
Psychosurgery, removal of organs for the purpose of
transplantation, and sterilization, shall not be performed at a State-operated
mental hospital.
ARTICLE VII GRIEVANCE AND APPEAL PROCEDURES
Statement of Principle.
To insure that these rights are safeguarded and that
disputes concerning their rights and others are resolved promptly and fairly,
patients must have the right to lodge grievances and appeals when informal
methods of resolving disputes are unsuccessful. Each facility shall have a
grievance and appeal system in effect. Every patient shall be informed of the
grievance and appeal system and shall be encouraged to utilize it when informal
methods of resolving complaints are unsuccessful.
1. Grievance Procedure.
(a) Any patient, or those helping him, may
initiate a complaint orally or in writing, concerning the exercise of these
rights or the quality of services and treatment at the facility. The complaint
shall be presented as soon as possible to the treatment team leader or other
appropriate person.
(b) Every
patient shall have the right to the assistance of an independent person and
witnesses in presenting his complaint.
(c) The treatment team leader, administrative
supervisor, or their designees receiving the complaint shall investigate the
complaint and make every effort to resolve it. Based upon this investigation, a
decision shall be rendered in writing as soon as possible but within 48 hours
after the filing of the complaint. Complaints shall be decided by persons not
directly involved in the circumstances leading to the grievance.
(d) The patient shall be given a copy of the
complaint and final decision and a copy shall be filed in the patient's record.
2. First Level Appeal.
(a) Any patient, or those helping him, may
appeal the grievance decision within 10 working days of the decision.
State-operated facilities shall follow the procedures set forth in this part.
Non-State operated facilities shall have in effect a fair and impartial appeal
procedure, which shall be reviewed by the county administrator.
(b) In a State-operated facility, standing
Rights Review Committee composed equally of facility staff and persons from the
community not affiliated with the facility shall hear the appeal and render a
written decision within 10 working days of the date of the appeal. Staff
members shall be appointed by the facility director. Until such time as the
committee is in effect, the appeal shall be heard by a hearing examiner
appointed by the regional deputy secretary. If the grievance requires immediate
action, the appeal shall be heard and decided as soon as possible.
(c) The patient shall be given prompt notice
of the date set for the appeal and shall be informed of his right to be
represented by counsel.
(d)
Hearings shall be informal, without strict adherence to the rules of evidence.
A sufficient record of the hearing shall be made.
(e) A copy of the decision shall be given to
the patient, the facility director, and filed in the patient's
chart.
3. Second Level
Appeal.
(a) Any patient in a State facility,
those helping him, or the facility director, may appeal the decision of the
hearing examiner or Rights Review Committee within 10 working days of the
decision. The appeal must set forth the specific objections to the
decision.
(b) The Secretary of
Public Welfare shall establish a standing Rights Appeal Committee composed
equally of Department and community personnel. Within 5 working days of receipt
of a second level request, the Committee shall review the decision of the
Rights Review Committee and may seek any additional information it deems
necessary.
(c) The patient shall be
given prompt notice of the date set for the appeal and shall be informed of his
or her right to be represented by counsel.
(d) Reviews shall be informal. A sufficient
record of the hearing shall be made.
(e) The Committee shall submit a
recommendation to the Secretary of Public Welfare within 10 working days of its
receipt of the second level appeal request. The Secretary will review the
findings and recommendations by the Committee and will issue a
decision.
(f) Nothing in this
section shall be construed as precluding a patient from instituting appropriate
legal proceedings.
This section cited in 55 Pa. Code §
5100.4 (relating to scope); 55 Pa.
Code §
5200.32 (relating to treatment
policies and procedures); 55 Pa. Code §
5100.52 (relating to statement of
principle); 55 Pa. Code §
5200.47 (relating to other
applicable regulations); 55 Pa. Code §
5210.56 (relating to other
applicable regulations); 55 Pa. Code §
5320.22 (relating to governing
body); and 55 Pa. Code §
5320.45 (relating to staff
orientation and training).
