Community Grievance Decision Digest

STAFF / PATIENT CONFLICTS

THE LAW:

Each patient shall... "Have a right to a humane psychological and physical environment within the hospital facilities.  These facilities shall be designed to... promote dignity and ensure privacy..."

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

Each patient shall... "Have the right to be treated with respect and recognition of the patient's dignity and individuality by all employees of the treatment facility or community mental health program and by licensed, certified, registered or permitted providers of health care with whom the patient comes in contact.”

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

“Each patient shall be treated with respect and with recognition of the patient’s dignity by all employees of the service provider and by all licensed, certified, registered or permitted providers of health care with whom the patient comes in contact.”

HFS 94.24(2)(b), Wis. Admin. Code [Emphasis added.]

DECISIONS

1.  An inpatient complained about lack of interactions with staff during her six-day stay.  Each patient’s needs and perceptions are unique, and staff cannot use a “one size fits all” approach.  There is a thin line between respect for a patient’s privacy and choices (e.g. to not have many interactions with others and to be given personal space), and going too far in the other direction (e.g., in trying to probe for interaction with many questions).  In the latter instance, the patient could have complained that she was not respected and not given reasonable space or privacy. Here, the record reflects a reasonable degree of staff attentiveness and vigilance and, in the latter part of the stay, more discussion with her about issues.  It was concluded that the patient’s right to a humane psychological and physical environment was not violated in this circumstance. (Level III decision in Case No. 99-SGE-08 on 3/23/01.)

2. A service recipient complained about her case manager yelling at her and pounding her fist on the table during a home visit.  The case manager admits doing this but said it was a demonstration of how she would act if she were, in fact, the type of controlling person that the service recipient described her to be.  This was an isolated incident, but the effect on the service recipient was very negative.  Even though it only happened once, it was a violation of the individual’s right to be treated with dignity and respect.  (Level III decision in Case No. 01-SGE-05 on 11/29/01.)

3.  On the day before her discharge, an Occupational Therapist (OT) made a comment to the patient to the effect that, “You won’t be embarrassed about walking into the dayroom naked and sitting down.”  She followed it up by saying, “Just kidding”. There was no further discussion between the OT and patient regarding the comment.  The patient did not tell the OT she found the comment distressing in any way, and the OT did not have any other indication that the patient had not accepted it in a humorous way.  In retrospect, the OT said she never would have used this comment or any reference to the word “naked” had she been aware of the sensitive connotation that may have had with the patient. The OT wished that the patient had stated her concerns at the time so they could have discussed them in a positive and solution-oriented way. The OT felt comfortable about using humor with this patient since she had responded well to humor being used in a therapeutic manner on prior occasions. Staff are not expected to interact only in a formal or robot-like manner with patients. There is ample room for humor in the course of mental health treatment. Had the OT known that the patient would find the comment distressing or demeaning rather than humorous, it would have been a rights violation to say it. Some comments are so egregious that, as a matter of law, they are rights violations – such as cursing at a patient, or making racial or ethnic slurs.  This comment does not fit that category.  Under these circumstances, the comment did not rise to the level of a rights violation. (Level IV decision in Case No. 01-SGE-08 on 8/27/02, modifying the Level III finding.)

4. The Level III decision found a violation of a complainant’s wife’s rights when her therapist called her at work to say she was discontinuing the therapy.  However, there was no evidence in the record that his wife told the therapist not to call her at work. This was a business call, rather than a personal call, and therefore it was not necessarily inappropriate for the therapist to call his wife at work. The finding of a rights violation was reversed. (Level IV decision in Case No. 02-SGE-07 on 3/10/04, reversing the Level III decision.)

5. A complainant accused his wife’s therapist of verbally accosting him in a public parking lot.  The record shows he attempted to obtain a restraining order against the therapist in court, but was unsuccessful.  Since he was unable to prove the matter in court, he failed to show that the therapist had violated his rights in those circumstances. (Level IV decision in Case No. 02-SGE-07 on 3/10/04, upholding the Level III decision.)

6.  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.)

7. A complainant alleged that the facility’s Client Rights Specialist (CRS) did not identify himself as such to him in a timely manner.  There was evidence in the record that the CRS’s name and title were provided to all patients at the facility.  If the individual was not re-informed of his title as CRS when discussing his issues with him, this was a technical violation of his rights. (Level IV decision in Case No. 02-SGE-07 on 3/10/04, modifying the Level III decision.)

8. An ex-patient complained about a lack of individualized treatment at a psychiatric hospital.  These concerns were meaningfully addressed when the hospital responded to his observations and concerns about the manner in which patients are assessed and treated. The hospital was planning a specific training session for staff to address indicators, features, and treatment approaches for Post Traumatic Stress Disorder and Parkinson’s Disease.  The training will also address the variables that could arise with men’s issues during treatment.  This staff training should lead to an improved awareness and create a better standard of care, greater dignity and respect for patients, and more individualized treatment decision-making.  Given the training initiatives planned, this issue was considered resolved. (Level III Decision in Case No. 03-SGE-07 on 4/22/04.)

Last Updated: November 13, 2006