Client Rights Limitations or Denials

Client Rights Limitation or Denial

Applies to: Any recipient of state or county funding in an in-patient facility who is receiving services for mental illness, a developmental disability, or substance abuse in the state of Wisconsin.

Under Sec. 51.61(2) Wisconsin Statutes (exit DHFS; PDF, scroll to page 53, bottom left) - State Alcohol, Drug Abuse, Developmental Disability and Mental Health Act, certain rights of inpatients may be denied for treatment, management, or security reasons. They are:

The right to make and receive telephone calls
The right to wear one’s own clothing and use one’s own possessions
The right to secure storage space
The right to privacy in toileting and bathing
The right to see visitors

These are the ONLY rights that may be limited or denied through this process.

A right cannot be denied even though the limitation would accomplish an intended treatment goal. Rights limits can be imposed only for as long as they are necessary to protect the treatment, management or security interest involved.

See HFS 94.05, Wisconsin Administrative Rules (exit DHFS; PDF, scroll to page 3) - Patient Rights and Resolution of Patient Grievances.

Some limitations can be long-term, however, if an individual continues to pose a danger to him or herself or others.

The law requires that any limits or denials of rights be documented. Staff of state-operated facilities are required by policy to use the Client Rights Limitation or Denial (CRLD) form (DDE-6100) (PDF, 10 KB) created for this purpose.

All other treatment providers are encouraged to use this form since it meets the documentation standards of the law. Instructions for completing DDE-6100 come with the form.

Rights limitations must be reviewed periodically by facility staff to see if they are still necessary.

At hospitals accredited by the Joint Commission for the Accreditation of Hospital Organizations (JCAHO), limits on phone calls and visitors must be reviewed weekly.

There is space on the form for documenting the reviews. If a limitation is long-term, there is a form (Client Rights Limitation or Denial Documentation Supplement, DDE-6100A (PDF, 8 KB) which can be used to document ongoing additional reviews.

The individual whose rights are limited or denied (or his or her guardian) must be given a copy of the documentation (or form DDE-6100).

Within two calendar days, copies of the rights limitation documentation must also be provided to the facility’s Client Rights Specialist and, if the individual is a county department patient, to the county’s Client Rights Specialist.

See HFS 94.05(4), Wisconsin Administrative Rules (exit DHFS; PDF - scroll to page 3)

Besides the rights listed above which may be limited or denied using the CRLD process, there may be other occasions when a service provider is considering limiting a client's rights.

There are circumstances where rights may be limited or denied for a variety of reasons under the client rights laws and code.

The following exceptions to rights should be reviewed in such circumstances to see if the right may be limited or denied other than through the CRLD process.

If there are no exceptions, then the right cannot be limited or denied. Even when exceptions do apply, the least restrictive measure must be taken.

Please note that the exceptions listed below are only a quick summary of the rights and their exceptions. Please refer to the Community Grievance Decision Digest for the complete law and rule by topic.

The Digest also summarizes the grievance decisions that have been made under that section of the laws and rules. "Inpatient" means any client receiving services in a residential setting.]

Right to:	Exceptions: (Can limit/deny for:)
Accusations - opportunity to refute	None - everyone should be have the chance to refute an allegation of a rule violation or claim mitigating circumstances
Arbitrary decisions - be free from	None - all decisions about clients must be rationally based on legitimate treatment, management, or security reason.
Businesses - conducting own	Inpatients may conduct any legitimate business, so long as it does not interfere with treatment, the orderly operation of facility, security, or other clients' rights.
Community - access to the	Inpatients should be allowed access to the community except for individualized security or safety reason.
Confidentiality of records	All records are confidential and can only be released with written consent, but there are specific exceptions to the consent requirement listed in § 51.30(4)(b), Wis. Stats.
Diet - nutritional diet and reasonable food choices	None - Inpatients must be provided a balanced, nutritional diet.
Diets - religious, cultural, personal	Inpatients are entitled to pursue their own religious or cultural diets or personal (like vegetarian) diets as can be provided.
Dignity & respect - treated with	All clients must be treated with dignity and respect under all circumstances.
Discipline - rule notice required	None - Rules should be in writing, but staff can verbally inform clients of rules and the possible consequences of violating those rules. It is harder to show actual notice if the rules are not in writing. Post them!
Drastic treatment - free from	None - Clients can refuse any drastic treatment procedures.
Environment - clean and safe	None - All inpatient facilities must be designed to be clean and safe.
Exercise opportunities	All inpatients must be given the opportunity for reasonable & regular exercise.
Filming or taping w/o consent	All filming or taping requires consent, but a facility can monitor common areas - just cannot tape. A picture of the client can be taken for the treatment record.
Funds - using own	All clients should be able to use their own funds as they wish - except for any guardianship and/or payee limitations. Inpatient facilities can limit amount of currency that clients can have on their unit.
Grooming / hygiene items access	Inpatients should have access to grooming items. However, if there is a safety issue involved, the right to possess such items can be limited by policy for a group of patients (e.g. staff keep razors for clients) or individually through the CRLD prograss if there is an item that one person cannot handle without supervision.
Informed of rights	All clients must be informed of their rights on admission, but this can be postponed for a short while if the client is not capable of understanding them upon admission. Annual re-notification must be given to long-term clients.
Informed of costs of care	All clients must be informed of the costs of their care on admission, but the service provider can give general costs (e.g. hourly) and an estimate of total costs.
Labor- of financial benefit to facility	Clients performing labor must consent to it and be paid at least minimum wage.
Labor- personal housekeeping	Inpatients can be expected to clean up after themselves and do light housekeeping work if the work is shared equally among clients.
Legal access to courts/ attorneys	No exceptions, but there may be extreme circumstances where legal calls, for instance, can be limited. Providers should seek legal advice for any such limits.
Mail - incoming, outgoing	Patients have a right to send and receive sealed mail. Mail can be opened (if it is not "legal mail") if there is probable cause to believe the letter may contain contraband. Otherwise, sending/receiving mail can be limited only court order or consent of the client or guardian.
Meal times - 30 minutes to eat	Inpatients must be given the full ½ hour to eat unless it is contraindicated for individuals for documented reasons.
Media access -TV, radio, etc.	Inpatients must have access to the media unless there is a documented safety or security reason for limiting the access.
Meds - no excessive, unnecessary	Medications must be appropriate to the client's condition and in dosages within normal ranges. Any deviations from that need to be well-documented by a physician.
Musical instruments - using own	Inpatients should be given the opportunity to use their own guitar, etc., except for documented safety or security reasons. Ttime & place limits may be imposed.
Off-unit access to exercise	Inpatients should be given access to exercise and other off-unit activities unless there are documented, individualized security or safety reasons for not allowing.
Outdoor access- regular & frequent	Can only limit for health reasons or for documented, individualized security reasons. Where necessary, the outdoor access can be supervised.
Recreation opportunities - access	Inpatients should be given access to recreational activities except for individualized security or safety reasons.
Refusing treatment /meds	Clients can refuse all treatment and medications unless court ordered.
Religious worship - attending	Inpatients should be allowed to attend on-unit religious activities unless the display disruptive behavior.
Religious worship -off-unit	Inpatients should also be allowed to attend off-unit religious activities unless there are documented security reasons for not allowing them to go.
Research - no experimental	Clients have to give their written, informed consent for all research.
Restraint - to be free from	Clients cannot be restrained except in an emergency when it is likely they pose a danger to self or others. Restraint must be used for the shortest time possible.
Room decorations - own room	Inpatients should be allowed to decorate their own rooms in any way they wish, but they don't have the right to display offensive or gang-related décor. An inpatient facility can restrict areas for clients who want to display sexually explicit materials (e.g. on the back of their room door where staff don't have to see it.)
Self-expression - art, music, etc.	Inpatient should be allowed to express themselves artistically unless there are documented safeties of security reasons for limiting it.
Safety - physical safety	Staff must protect inpatients from safety hazards, including other patients.
Search of person	Only inpatients may be subject to personal searches. (see HFS 94.24(d)1).
Search of room	Only inpatients can be subject to a search of their rooms and only where there is "probable cause" to believe security rules have been violated.
Seclusion - to be free from	Clients cannot be secluded unless in an emergency where it is likely they will pose a danger to self or others. Seclusion must be used for the shortest time possible.
Snacks - between-meal	Snacks must be accessible to inpatients, except when contraindicated for individual clients.
Social contact with members of the opposite sex	Inpatients should be allowed to mix with the opposite sex unless there are treatment, safety or security reasons for limiting it.
Toilet access	Access to a toilet and sink must be unscheduled, except a client in seclusion must be allowed access every 30 minutes.
Treatment participation	All clients should participate in the planning of their treatment and care, but the client does not necessarily get to "pick and choose" the parts of the plan the client likes best. The client's treatment team makes the final decisions about what is the most appropriate treatment. The client can refuse the treatment or ask for a second opinion if they disagree.
Treatment - prompt & adequate	All clients are entitled to treatment that is appropriate to their condition and delivered promptly and adequately.
TV, radio, etc - buying their own	Inpatients should be allowed to purchase their own TV's, etc., but this can be limited per policy for security, treatment, safety reasons, or individually through a CRLD.

Reminder: the above exceptions are only a quick summary of the rights and their exceptions. Please refer to the Community Grievance Decision Digest for the complete law and rule by topic.

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Last Updated: February 12, 2007