Current through Reg. 49, No. 38; September 20, 2024
(a) Patients rights are guaranteed under the
provisions of this subchapter. Although under special circumstances set out in
this subchapter, certain rights can be limited without informed consent, it is
usually mandatory and always preferable to obtain informed consent when
limitation of rights is contemplated.
(b) Except as otherwise noted in this
subchapter, written informed consent must be obtained when a right guaranteed
by law or department rule is limited.
(1) The
patient or legally authorized representative gives informed consent. Written
informed consent is obtained from the:
(A)
adult individual, if legally competent and deemed to be capable of
understanding the required elements which constitute informed
consent;
(B) guardian of the person
of the adult individual if there has been a determination of mental
incompetence by a court; or
(C)
parent or managing conservator of a minor under the age of 16.
(2) Informed consent must be
documented. Written informed consent is evidenced by a completed copy of the
department's form for "Consent to Behavior Intervention," referenced as Exhibit
A. Psychiatric hospitals and CSUs may use a different form provided that it
includes all of the information included on the "Consent to Behavior
Intervention" form.
(3) Informed
consent may be withdrawn at any time. If informed consent is withdrawn, the
program must be discontinued immediately, and the treatment team must meet
within three working days to modify the individual's treatment plan. Withdrawal
of consent may be in any form including, but not limited to, passive
noncompliance, active resistance, or a verbal or other expression of
unwillingness to continue participating in any aspect of the program.
(4) The limitation of the right or rights
must be reviewed by the physician as appropriate but must occur at least on a
monthly basis, unless otherwise specified.
(5) Informed consent must be renewed. Written
informed consent must be reviewed and renewed every six months.
(c) Any limitation on rights is
included as a part of the individual's comprehensive treatment plan. The
treatment plan also includes a program that emphasizes positive approaches and
uses positive behavioral interventions.
(d) It is prohibited for limitation on rights
to be used:
(1) in retribution, as punishment,
or as a means of controlling an individual by eliciting fear;
(2) for the convenience of staff or as a
consequence of insufficient staff;
(3) as a substitute for a comprehensive
treatment plan; or
(4) in the
absence of positive behavioral interventions.
(e) Any limitation on rights will not:
(1) deprive an individual of a basic human
need (e.g., a bed at night, food, personal clothing, etc.) or the essentials of
a normal hospital environment; or
(2) alter the texture of a food item or use
techniques that could result in failure to provide a nutritiously adequate
diet. Foods used as edible reinforcers within a behavior intervention program
are evaluated by the treatment team, including a qualified dietitian and
physician, with consideration of the individual's nutritional status, needs,
and preferences.
(f)
Additional approval required. Written informed consent must be obtained for
behavior intervention programs using highly restrictive interventions.
Additionally, the use of any procedures or programs employing aversive
techniques, such as, but not limited to, faradic stimulation, require the
unanimous documented written approval of the medical director of the facility,
the CEO, and the Ethics Committee.
