Community Grievance Decision Digest

INFORMED OF RIGHTS, RIGHT TO BE

THE LAW:

Each patient shall:  "Upon admission or commitment be informed orally and in writing of his or her rights under [s. 51.61].  Copies of this section shall be posted conspicuously in each patient area, and shall be available to the patient's guardian or immediate family."

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

"(1) At the time of admission or, in the case of an outpatient, before treatment is begun, the patient shall be notified both orally and in writing of his or her rights in accordance with s. 51.61(1)(a), Stats., and this section.  The guardian of a patient who is incompetent and the parent of a minor patient shall also be notified, if they are available.  Notification is not required before admission or treatment when there is an emergency.

(2) If a patient is unable to understand the notification of rights, written and oral notification shall be made to the parent or guardian, if available, at the time of the patient's admission or, in the case of an outpatient, before treatment is begun, and to the patient when the patient is able to understand.

(3) All notification of rights, both oral and written, shall be in language understood by the patient, including sign language, foreign language or simplified language when that is necessary.  A simplified, printed version of patients rights shall be conspicuously posted in each patient area. 

HFS 94.04, Wis. Admin. Code [Emphasis added.]

Access to Records following discharge:

“2.  The subject individual shall have a right, following discharge under s. 51.35(4), to a complete record of all medications and somatic treatments prescribed during admission or commitment and to a copy of the discharge summary which was prepared at the time of his or her discharge.  A reasonable and uniform charge for reproduction may be assessed. 

3.  In addition to the information provided under subd. 2, the subject individual shall, following discharge, if the individual so requests, have access to and have the right to receive from the facility a photostatic copy of any or all of his or her treatment records.  A reasonable and uniform charge for reproduction may be assessed.  The director of the treatment facility or such person's designee and the treating physician have a right to be present during inspection of any treatment records.  Notice of inspection of treatment records shall be provided to the director of the treatment facility and the treating physician at least one full day, excluding Saturdays, Sundays and legal holidays, before inspection of the records is made.  Treatment records may be modified prior to inspection to protect the confidentiality of other patients or the names of any other persons referred to in the record who gave information subject to the condition that his or her identity remain confidential.  Entire documents may not be withheld in order to protect such confidentiality.

4.  At the time of discharge all individuals shall be informed by the director of the treatment facility or such person's designee of their rights as provided in this subsection."

§ 51.30(4)(d), Wis. Stats. [Emphasis added]

DECISIONS

1. An intense inpatient AODA program requires 24-hour, 7-day a week involvement of the patient for up to 30 days.  Where this is explained to all patients upon intake, the patients’ right to notification of their rights is not violated. (Level III decision in Case No. 98-SGE-02 on 10/13/98, upheld at Level IV.)

2. Where a methadone clinic did not ensure that all clinic employees were aware of patient rights and the grievance process, they violated the patients’ rights. (Level III decision in Case No. 99-SGE-02 on 5/17/00.  Appeal to Level IV by the patient was dismissed since the Level III decision was in his favor.)

3. A patient received services from an agency contracted by the county.  He felt he was not adequately informed of his patient rights because his rights were provided in a perfunctory way, without dialog or the ability on his part to ask questions or seek further clarification.  He wanted clarification of the notification requirements and expectations. Given his requested relief, there was no conclusion made that the provider was out of compliance, but recommendations were made for further review of the agency’s rights notification process. (Level III decision in Case No. 00-SGE-01 on 6/29/01.)

4. The notification of rights is a very important task as it is intended to convey to clients that, indeed, they have many rights while receiving services, and that there are mechanisms designed to protect their rights – such as the HFS 94 grievance resolution procedure.  Yet, as clients begin receiving services, they may be at various functioning levels in terms of their ability to process this information and understand their rights. The law emphasizes the need for flexibility and follow-up by providers as may be warranted in any given situation.  For example, if a client is admitted to an inpatient setting in an acutely psychotic state, that may be a time when the rights are the least meaningful or understandable.  Thus, someone will need to follow up with the rights notification at a later time when the client is more likely to understand them.  There are creative and effective ways in which information can be shared, explained, and discussed to make it meaningful. Usually some combination of oral notification (unless a client states that is not wanted) and written notification followed by an opportunity to ask questions, discuss what the rights mean, ensure the client knows who the Client Rights Specialist is, etc., is effective. The key part of this entire process is documentation.  Having a patient sign an acknowledgement of receipt of rights information is always a good idea but, without more, this alone is not always meaningful. If there is a question later, additional and contemporaneous documentation about what the rights notification process entailed is a good protective measure for both a client and agency. It is always positive to include such documentation in the client’s record. Documentation of annual re-notification of rights is also necessary.  Who does the follow-up in up to the provider, but logically the Client Rights Specialists should have some role. (Level III decision in Case No. 00-SGE-01 on 6/29/01.)

5. It is not necessary for each treatment staff person of a clinic, hospital or treatment program to notify a client of his or her rights and the grievance process.  One timely notification prior to the patient beginning his or her treatment is sufficient. (Level III decision in Case No. 03-SGE-01 on 7/16/03.)

6. Even though the HFS 94 grievance process has no jurisdiction over an independent physician delivering services through an office that is not part of a program, the physician was still obligated to inform his patients of their rights under Sec. 51.61, Wis. Stats. And, when the physician became part of an organized service corporation, he was also obliged to inform his patients that the HFS 94 grievance process applied as of that time.  (Level III decision in Case No. 03-SGE-01 on 7/16/03.)

7. A client complained about lack of access to the HFS 94 grievance procedure at a clinic. It was determined that the clinic does have a Client Rights brochure, which the client was able to get a copy of.  The brochure outlines the HFS 94 grievance procedure.  The clinic was reminded that they need to put the name and contact information of the clinic’s Client Rights Specialist on all their brochures.  (Level IV decision in Case No. 06-SGE-01 on 4/3/06)

Last Updated: November 07, 2006