Community Grievance Decision Digest

TREATMENT PARTICIPATION

THE LAW:

Each [patient] shall... “Have the right to be fully informed of his or her treatment and care and to participate in the planning of his or her treatment and care.”

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

“Each patient shall be informed of his or her treatment and care and shall be permitted and encouraged to participate in the planning of his or her treatment and care.” 

HFS 94.09(1), Wis. Admin. Code [Emphasis added.]

DECISIONS:

1. A patient wanted to bring a friend to her therapy sessions.  The service provider agreed that there are times that it may be appropriate, especially if the person is a primary support person for the client. Bringing another person to a therapy session requires a signed release from the patient.  Since the requested remedy was provided here, this issue was considered resolved. (Level III decision in Case No. 00-SGE-03 on 9/12/01.)

2. A service recipient felt her case manager was too controlling of her life.  She usually accompanied the individual to her doctor appointments, but did most of the talking.  However, the doctor had ordered the case manager to monitor the individual’s psychotropic medications and to visit her weekly.  Thus, it was appropriate for the case manager to accompany her and report to the doctor.  The individual also had private appointments with her doctor, so her right to treatment was not violated. (Level III decision in Case No. 01-SGE-05 on 11/29/01.)

3. 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.  But her interim plan for transitioning to group therapy was not documented or consented to by the patient.  Thus, her right to treatment and her right to informed consent were violated.  It was recommended that the service provider create a space on its treatment plans for the patient’s signature and that they fully document all services received by the patient.  (Level III decision in Case No. 01-SGE-09 on 3/27/02.)

4. A patient wanted to choose a new psychiatrist after her case was transferred from a doctor she had been seeing to another doctor.  The service provider tried to accommodate her request, but the two psychiatrists she asked for declined to accept her on their caseloads.  The accommodation attempts were reasonable.  No violation of her rights was found. (Level III decision in Case No. 01-SGE-09 on 3/27/02.)

5. Patients have the right to involve their spouses in home-visit treatment sessions unless their participation is contraindicated for treatment reasons.  The service provider should either allow such participation or explain to the patient why it is contraindicated.  The patient would have to sign a release of information to allow the spouse to be present during treatment sessions. (Level III decision in Case No. 01-SGE-09 on 3/27/02.)

6. A patient’s treatment plan focused on the patient’s suicidal ideation and safety. His doctor developed the plan based on the information he had at the time.  Where the patient claimed, at a much later dated, that he lied to the doctor, his right to prompt and adequate treatment was not violated.  (Level IV decision in Case No. 99-SGE-05 on 3/29/02, upholding the Level III.)

7. A therapist did not present his written assessment and treatment plan to the patient prior to beginning treatment.  The treatment plan was developed after the first session but not signed by the patient until after the third session.  The plan should have been provided to the patient prior to his second session. This was a violation of the patient’s rights to participate in his treatment planning and to provide informed consent for treatment.  (Level IV decision in Case No. 01-SGE-07 on 3/29/02, reversing the Level III decision.)

8. A complainant claimed he was not allowed to participate in the planning of his treatment with regard to joint marriage counseling.  It was found that these were individual sessions for his wife in which he was invited to be present.  No rights violation was found since it was not his treatment that was involved.  It was conclude that joint marriage counseling, per se, is not mental health treatment to which “patient rights” apply. There was no violation of his rights, even if it was joint marriage counseling.  (Level IV decision in Case No. 02-SGE-07 on 3/10/04.)

9. 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 to restore 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)

10. An outpatient client alleged that her right to ongoing participation in her treatment planning was violated.  The right to participate in the planning of treatment interventions and modalities is continuous and ongoing throughout the course of treatment. But it is limited by both the therapist’s abilities and the therapist’s professional decision-making.  That is to say, clients do not have the right to direct their therapy, but rather to offer insight and feedback about what they believe is effective treatment for them. (Level III Grievance Decision in Case No. 05-SGE-12 on 5/16/06)

11. A client’s right to be treated with dignity and respect was violated by the lack of shared decision-making and collaborative planning during the evaluation and assessment phase of her services. While the service provider does maintain the right to choose which clients they will or will not see, their assessment and evaluation of a client’s treatment needs should also recognize and respond to a client’s request for more frequent visits.  They need to clearly define the purpose of the assessment and set reasonable expectations for the client.  (Level III Decision in Case No. 05-SGE-003 on 6/8/06)

Last Updated: November 13, 2006