Community Grievance Decision Digest

ARBITRARY DECISIONS, RIGHT to be FREE FROM

THE LAW:

Each patient shall... "Have a right to a humane psychological... environment within the hospital facilities..."

§ 51.61(1)(m), Wis. Stats. [Emphasis added 

“Patients have the right to be free from having arbitrary decisions made about them.  To be non-arbitrary, a decision about a client must be rationally based upon a legitimate treatment, management or security interest.” 

HFS 94.24(3)(h), Wis. Admin. Code [Emphasis added.]

The treatment facility shall maintain a patient treatment record which shall include:  “Documentation that is specific and objective and that adequately explains the reasons for any conclusions or decisions made regarding the patient.”

HFS 94.09(6)(d), Wis. Admin. Code [Emphasis added.]

DECISIONS

1. A county found a 17-year old ineligible for developmental disabilities services.  She had been diagnosed as having a developmental disability at the age of 6 months.  At the age of 12, she was diagnosed as autistic by a multi-disciplinary team of professionals.  Autism is developmental disability that is a life-long condition. The question was whether or not she met the eligibility threshold of a 30% or more functional limitation in at least two of five areas of skills.  The county conceded she met that threshold in the area of “self-direction and independence”.  The records indicate that she also meets the threshold in the area of “self care”. Thus, she should have been eligible for the county’s programs.  Her right to prompt and adequate treatment was violated by the county’s denial of her eligibility.  (Level III decision in Case No. 98-SGE-03 on 11/10/98.)

2. A mother complained that her son’s condition was worsening since his medications were discontinued.  Her son’s doctor was on maternity leave and the service provider would not temporarily assign him to another doctor. She was instructed to call back when the doctor may have returned.  But they never attempted to ascertain exactly when the doctor would come back.  The service provider violated the son’s right be free from arbitrary decisions being made about him. (Level III decision in Case No. 00-SGE-08 on 7/28/00, upheld at Level IV.)

3. Financial assistance for housing is not an issue covered by client rights and such decisions cannot be challenged in the grievance process in HFS 94. (Level III decision in Case No. 01-SGE-02 on 6/6/01.)

4. A patient wanted to continue the individual therapy she had received for 9 years, but the service provider shifted to only doing group therapy with her.  She had been made aware months in advance of the upcoming change in services.  The treatment team agreed that this change was appropriate for her treatment needs. Thus, her right to treatment and her right to be free from arbitrary decision-making were not violated.  (Level III decision in Case No. 01-SGE-09 on 3/27/02.)

5. A man complained on his wife’s behalf that she was given a new therapist without consulting her first.  A treating facility has the right to change therapists for business management reasons.  It is good practice to consult with the patient first, but it does not rise to the level of a rights violation not to do so. (Level IV decision in Case No. 02-SGE-07 on 3/10/04, reversing the Level III decision.)

6. A methadone clinic took away a client’s Sunday take-home privileges after some incidents.  The client had a positive breathalyzer test result for alcohol, had lost her take-home bottle, and had taken an overdose of another medication.   She was informed in writing of the requirements for restoring her Sunday take-home privilege, which included having no positive breathalyzers for alcohol and obtaining a letter from her psychiatrist stating that in his/her best clinical judgment that she was responsible and could handle her Sunday take home bottle. Her right to be treated fairly was not violated because the clinic had significant, appropriately documented reasons to take away her Sunday take-home dose. The Sunday take-home dose was eventually restored in an individualized and appropriate manner.  (Level III decision in Case No. 04-SGE-02 on 12/20/04)

7. A client of a methadone clinic had difficulties receiving psychiatric treatment for anxiety that was accessible and affordable to her and which was also acceptable to the clinic.  She found one she liked, but was told to quit seeing him by the clinic or her services would be terminated.  The psychiatrist in question does not have a good reputation in the field of substance abuse treatment because he has a reputation for prescribing medications that may not be appropriate. She then found a new psychiatrist who charged more and was less accessible for her to visit.  Her right to choose her own psychiatrist was not violated because the clinic had good reasons to ask her to see a different psychiatrist. It was not an arbitrary decision by the clinic in these circumstances.  (Level III decision in Case No. 04-SGE-02 on 12/20/04)

8. The primary rationale for the proposed change in vocational services for a client was economic.  The county Health and Human Services program faced increasing waiting lists for people who need services while having less fiscal support to provide those services.  In the face of a decreasing budget, the HHS was looking at areas where money could be saved.  The costs of continuing this client’s current vocational service provider were considerably more than other, similar providers in the area.  It was reasonable for the county to consider cutting costs without cutting programs. The client rights question was whether or not the other providers would be able to offer like services that adequately met the client’s individualized needs and supported her right to receive prompt and adequate treatment appropriate to her condition.  It was found that the support services the other vocational provides could offer would be comparable.  The client would continue working in the same settings at the same times, and with a support person available for the same amount of time.  The changes would necessarily include different persons providing those services and doing so under a different organizational structure.  However, the vocational services would essentially be the same under the county’s proposal.  The county’s request that the client choose between two other, less expensive, vocational services providers was reasonable and fair.  The need to serve as many clients as possible outweighs the potential benefits of one individual to continue receiving services from a more costly service provider than is necessary to provide support services in a similar manner that other agencies may provide in the same setting.  Thus, requiring the client to choose between the two less expensive of three possible providers was not a violation of her rights.  (Level III decision in Case No. 03-SGE-09 on 4/11/05)

Last Updated: November 07, 2006