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Community Grievance Decision Digest

TREATMENT, RIGHT TO PROMPT AND ADEQUATE

Laws and Previous Decisions (1-15)  - Decisions (31 - 39)

DECISIONS 16-30:

  1. A PRN (“as indicated”) order does not mean the patient will receive the medication upon demand.  A qualified medical professional, such as an RN, must make the clinical decision as to whether or not it is appropriate for the patient, based on an assessment of the patient’s condition at the time.  (Level IV decision in Case No. 99-SGE-05 on 3/29/02, upholding the Level III.)

  2. A complainant raised issues regarding the “couples therapy” he and his wife received. At Level II of the grievance process, it was concluded that the complainant was not a client, in the context of therapy that was provided, and thus did not have access to the grievance process.  At Level III, it was concluded that the complainant was a patient by definition since he was referred to as such numerous times in the treatment records, had his own diagnosis, and had a joint “treatment plan” with his wife. Thus, he had access to the grievance process like any other “patient”.  (Level III decision in Case No. 00-SGE-11 on 4/30/02, dismissed at Level IV for lack of standing to appeal because the ruling was in his favor at Level III.)

  3. A grievance must be filed within 45 days of the occurrence of the event or circumstances or of the time when the event or circumstances “should reasonably have been discovered” or whichever comes last.  Here, a minor’s prior physician apparently misdiagnosed him.  The minor was later correctly diagnosed and appropriately treated during a stay at a state mental health facility. His parents filed a grievance about his original misdiagnosis seven months after his discharge from the state facility. The grievance was not timely filed. The program director’s refusal to accept this late complaint was an exercise of his discretion.  He could have accepted the complaint, but chose not to.  He did not abuse his discretion.  In fact, there would have been little point in accepting it since the doctor in question was no longer working for the program.  (Level III decision in Case No. 03-SGE-01 on 7/16/03.)

  4. In general, the treatment decisions of professionals are afforded “due deference” by peers and by the courts.  However, if a treatment decision “departs from professional judgment”, the patient’s right to treatment may have been violated.  A “departure from professional judgment” may be evinced in any of three ways:  a) where the evidence suggests that the professional exorcised no judgment at all; b) where the individual was not qualified to make the judgment; or c) where a decision was made on an impermissible basis (e.g., as “punishment”). (Level IV decision in Case No. 02-SGE-04 on 9/19/03.)

  5. There must be sufficient evidence to show it was more probable than not that a doctor departed from professional judgment in his prescribing medication to a patient after a phone call with her.  Such evidence would have to come in the form of a second opinion from a professional of equal or greater standing than the doctor. Where there was no such evidence presented, the finding of a rights violation at Level III will be overturned.  (Level IV decision in Case No. 02-SGE-04 on 9/19/03, overturning the Level III.)

  6.  In a situation where a suicidal patient has been put on a new medication, then cancels her next appointment with the doctor, the clinic has a duty to at least have someone review the situation to see if follow-up contact with the patient is necessary. There was no evidence that this was done here.  While it could be assumed that, as a voluntary patient, she was exercising her right to discontinue treatment, there should have been some determination made as to whether or not to contact her.  The clinic thus violated the patient’s right to prompt and adequate treatment by not making that determination. (Level IV decision in Case No. 02-SGE-04 on 9/19/03.)

  7. Patients have the right to have their care and treatment coordinated with other treatment staff who are involved in their care and treatment.  A doctor ordering a change in a patient’s medication must ensure that other members of the patient’s treatment team are informed about the new medication and the expected benefits and potential adverse side effects which may affect the patient’s overall treatment. (Level IV decision in Case No. 02-SGE-04 on 9/19/03.)

  8. Where a doctor knew or should have known that his patient was seeing other professionals involved in her care, the doctor has a duty to at least attempt to inform the other therapist involved of a change in medication.  If the patient’s consent is required, the doctor should ask for it.  Where no such attempt was made here, the doctor violated the patient’s rights. (Level IV decision in Case No. 02-SGE-04 on 9/19/03.)

  9. A mother believed a therapist acted unprofessionally in working with her daughter by not reporting various risky behaviors in which her daughter was engaged.  The therapist was aware that her daughter tried to commit suicide, purposely cut herself many times, used illegal drugs, and engaged in underage sex with multiple partners. The mother thought the therapist should have reported all these incidents to proper authorities.  She requested disciplining the therapist  – including possible license revocation. The records indicated that the suicidal ideation expressed by the daughter was taken seriously. Appropriate referral resources were immediately offered to her parents. The daughter was also placed on a medication for depression. For the next seven subsequent sessions the therapist inquired about and documented the daughter’s present mental status and thoughts of suicide or dying.  Each entry includes some statement indicating that she was asked if she was seriously contemplating suicide or hurting herself.  She responded that she was not having thoughts about suicide or hurting herself over the following months. Therefore, her right to prompt and adequate treatment was met. The therapist was not obligated to initiate social services intervention into her family life, or to notify any other authorities. (Level III Decision in Case No. 03-SGE-02 on 12/26/03.)

  10. 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.)

  11. Methadone is a nationally recognized treatment modality for heroin addiction.  Where a patient has done well on a methadone program, staying drug-free for a period of 18 months, the continuation of outpatient treatment for her is appropriate.  It is also the least restrictive alternative to inpatient treatment. (Level IV decision in Case No. 99-SGE-01 on 5/16/04.)

  12. Someone in a methadone treatment program can ask for a “fair hearing” only when they have been involuntarily terminated from the program. (Level IV decision in Case No. 99-SGE-02 on 5/24/00.)

  13. 13. The individual’s right to treatment includes specific protocols as necessary to ensure health and sanitary living conditions. The treatment needs of the client need to be considered and clearly documented in the contract between the county and any contract agencies, with a plan for monitoring and updating those treatment goals.  Any barriers to achieving these needs must be documented, the guardian must be informed, and a plan to resolve such issues needs to be implemented.  These treatment protocols are an essential feature for the treatment and management of the client, and they are an integral part of the client’s right to prompt and adequate treatment.  (Level III Decision in Case No. 03-SGE-04 on 6/15/04.)

  14. The sister/guardian of a woman filed a grievance about the care the woman had received while she was living in her own apartment.  She had been receiving supportive home care services from an independent service provider under a general contract with the county.  The guardian alleged “abuse of a vulnerable adult” because the woman’s apartment was not kept clean by the contractor and was “unlivable due to filth”.   The contract contained no specific requirements, but there was a list of duties for the staff who visited her apartment.  One duty was to clean the apartment weekly. During one particular period, the contractor’s employees did not complete many of the required items and the apartment became very dirty.  Instead, they spent the time providing companionship to the woman. Regardless of her desire for companionship, the employees were responsible for keeping the apartment clean. Whenever possible the caregivers should be making sure the task list is completed while working with the client to model those skills, and to create a social situation where tasks can be completed together and in a way that is therapeutic for her by reinforcing daily living skills. The contractor violated her right to a humane environment.  (Level III Decision in Case No. 03-SGE-04 on 6/15/04.)

  15. The individual’s right to treatment includes specific protocols as necessary to ensure health and sanitary living conditions. The treatment needs of the client need to be considered and clearly documented in the contract between the county and any contract agencies, with a plan for monitoring and updating those treatment goals. Any barriers to achieving these needs must be documented, the guardian must be informed, and a plan to resolve such issues needs to be implemented. These treatment protocols are an essential feature for the treatment and management of the client, and they are an integral part of the client’s right to prompt and adequate treatment. (Level III Decision in Case No. 03-SGE-04 on 6/15/04.)

Next Set of Decisions

Last Updated: November 13, 2006