Community Grievance Decision Digest

TREATMENT, RIGHT TO PROMPT AND ADEQUATE

Laws and Previous Decisions (16-30)

DECISIONS 31 - 39:

31. A psychiatrist prescribing the medications has the ultimate authority to make individualized decisions for each patient.  Individualized decision making is a key element for providing prompt and adequate treatment services appropriate to each individual patient’s condition.  While the majority of patients may not be suitable for a full disbursement of their medications, psychiatrists and treatment providers need to recognize individuals who are stable and consistent with their treatment programs and accommodate their request for dispensing increased amounts of medications at one time accordingly. (Level III Decision in Case No. 03-SGE-08 on 7/14/04.)

32. 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)

33. Clients throughout the state receive different services from different providers who work together as parts of the service delivery system. The key to maintaining quality services and an effective continuity of care and treatment is the use of effective communication protocols between agencies. All agencies involved are expected to communicate and cooperate for the benefit of their clients and in accord with the right to provide prompt and adequate treatment and excellent continuity and coordination of services. (Level III decision in Case No. 03-SGE-09 on 4/11/05)

34. A client in need of a very specific type of therapist alleged that the county department of community programming was not coordinating her services adequately. While some of their correspondence and efforts to assist her could have been more timely, she was receiving treatment during the time she allege the lack of coordinated services. This situation did not rise to the level of a patient rights violation.  (Level III Grievance Decision in Case No. 04-SGE-07, affirmed at Level IV on 8/15/05)

35. A psychiatrist determined that the therapeutic rapport between himself and one of his clients had been irrevocably damaged. That presented a valid treatment reason for discontinuing his services to that client.  The agency the psychiatrist worked for gave the client adequate notice and time to find a replacement psychiatrist and also suggested possible alternatives.  The client was also appropriately referred back to his own county.  The client’s rights were not violated.  (Level IV decision in Case Nos. 05-SGE-06 and 05-SGE-08 on 12/15/05)

36. An outpatient mental health client believed she needed financial counseling and that this should have been brought to her attention by her therapist.  While it is recognized that clients in the midst of stressful situation often lack the insight to identify these kinds of needs on their own, this allegation does not rise to the level of a patient rights violation.  The treatment she was receiving was for psychological issues.  It was reasonable for her therapist to believe that the client could identify and address her financial concerns without explicit direction from her therapist.  (Level III Grievance Decision in Case No. 05-SGE-12 on 5/16/06)

37. The adequacy of the treatment a client received during the last six months of treatment was difficult to ascertain.  Treatment records were minimal, the treatment occurred years ago in the past, and there are some differences of recollection between the client and the therapist.  However, based on all available information, it seemed likely that the therapist was providing adequate treatment based on her perception of the client’s treatment needs.  While it is carefully considered that the client did not agree with the therapist’s perception of her treatment needs nor the manner in which treatment was provided, it is difficult to prove that the treatment was not adequate based on the available facts. While it was recognized that the treatment she received was not optimal, there was insufficient evidence to substantiate the allegation that the treatment was not adequate.  (Level III Grievance Decision in Case No. 05-SGE-12 on 5/16/06)

38. Ideally, treatment should be provided in the most integrated and comprehensive manner possible.  While each treatment professional may only act within the scope of their own professional capacity, communication between professionals (with the client’s consent) is an option.  Professional collaboration can help provide an integrated mind/body perspective.  In a situation where a client is in a state of emotional or psychological distress, it may be appropriate for a therapist to request the client’s consent to communicate with her other treatment professionals, such as her gynecologist.  This is particularly pertinent when the client may lack insight or the ability to process all facets of medical or psychological information at the time.  However, it did not rise to the level of a rights violation where there were indicators that the client’s physical health care needs were being met and the client desired confidential services. In this situation, it was not necessary or appropriate for the therapist to request a release to talk with the client’s other medical professionals.  Identifying a client’s physiological health care needs is not an expectation or responsibility of a psychotherapist.   (Level III Grievance Decision in Case No. 05-SGE-12 on 5/16/06)

39. A diagnosis made by an independent, outpatient clinician was that clinician’s opinion, which cannot be challenged in the grievance process.  The client has the right to get a second opinion if she disagrees with the diagnosis. (Level IV decision in Case No. 06-SGE-09 on 9/27/06)

Last Revised:  October 24, 2008