§ 5100.54. Manual of rights for persons in treatment.

 The following is the manual of rights for persons in treatment:

 Article I: The Right to Communicate

Statement of Principle


   1. Right to Information

   2. Right to Assistance

   3. Right to an Attorney

   4. Right to Have Visitors

   5. Right to Send and Receive Letters

   6. Right to Use Telephones

 Article II: The Right of Religious Freedom

Statement of Principle


   1. Right to Refuse Medication

   2. Right to Diets Based on Religious or Ethical Consideration

   3. Right to Abstain from Religious Practices

 Article III: The Right to Handle Your Personal Affairs

 Article IV: The Right to a Humane Physical and Psychological Environment

 Article V: The Right to Treatment

Statement of Principle


   1. Individualized Treatment Plan

   2. Discharge

 Article VI: Permissible, Restricted and Prohibited Treatment Procedures

Statement of Principle


   1. Permissible Procedures

   2. Restricted Procedures

   3. Prohibited Procedures

 Article VII: Grievance and Appeal Procedures

Statement of Principle


   1. Grievance Procedures

   2. First Level Appeal

   3. Second Level Appeal

ARTICLE I
THE RIGHT TO COMMUNICATE



 Statement of Principle.

 (a)  Every patient has the right and shall be encouraged to communicate freely and privately with others within the facility and in the community at large, as described below. This is based upon the firm belief that meaningful communications are essential to a successful course of treatment. These rights may be suspended or restricted for a limited period by the treating physician only when reasonable cause exists to believe that failure to suspend communications will result in a substantial risk of serious and immediate harm to the patient or others, or that a crime is being committed. The physician shall fully explain any suspensions or restrictions of these rights to the patient and document the reasons for the restriction in the patient’s record. Suspension or restrictions shall be reviewed and documented every 48 hours until the risk of serious and immediate harm is reduced.

 (b)  Every patient shall have the right to make complaints and offer suggestions to the director, or his designee, regarding the operation of the facility, and may meet with other patients to discuss their concerns with facility administrators. Complaints and suggestions shall be heard and decided promptly.
1. Right to Information.

 (a)  Every patient has the right to be informed of his rights and responsibilities while in treatment, and those house rules and regulations of the facility which affect his treatment.

 (b)  Every patient has the right to be informed of diagnostic and treatment procedures, their risks and their costs, that are available to him and which would aid in his recovery from mental illness. Patients have the right to be informed of the reasons and factors involved in recommending a procedure of choice.

 (c)  Every patient has the right to be informed of the nature of material about to be released to others (or obtained) when he is requested to sign a release of information.
2. Right to Assistance.

 (a)  Every patient shall have the right to the assistance of an independent person not a member of his treatment team to resolve a problem raised by the patient.

 (b)  Each non-State facility shall designate one or more persons either on a volunteer or staff basis as needed to help patients in this manner.

 (c)  State facilities shall designate one or more staff to aid patients, and these persons shall be accessible during regular working hours.

 (d)  Every State facility shall advise and educate all patients about the availability and services of this program.

 (e)  These persons will be responsible for assisting or supporting the patient in meeting with the appropriate person to discuss the problem and possible solution. They shall maintain a confidential file of requests for service and subsequent actions taken. The file shall be open to review only by the facility director or the patient’s Attorney and shall be filed with the patient’s clinical record upon discharge. They have no authority to directly resolve problems but may report his or her findings directly to the facility director.
3. Right to an Attorney.

 (a)  Every patient has the right to retain an attorney of his choice to assist the patient in asserting his rights to treatment or release or to aid the patient in any other matter.

 (b)  The facility will provide patients with referral information and other non-monetary assistance to enable patients to implement this right. The names, addresses and telephone numbers of legal services and other available advocates in this area shall be given to all patients.

 (c)  Every patient has the right to see or telephone his attorney in private at any reasonable time, regardless of visiting hours.
4. Right to Have Visitors.

 (a)  Every patient has the right to receive visitors of his own choice daily, within established visiting hours, in a setting of reasonable privacy conducive to free and open conversation unless a visitor or visitors are determined to seriously interfere with a patient’s treatment or welfare.

 (b)  Established visiting hours shall attempt to meet the needs of individual patients and visitors, and may be waived to the extent feasible to accommodate special circumstances or the needs of individual patients.
5. Right to Send and Receive Letters.

 (a)  Every patient has the right to send unopened mail. Reasonable amounts of such mail shall be stamped free of charge if sufficient personal funds are not available.

 (b)  Writing materials shall be made available to patients on a daily basis and an opportunity provided for writing letters and other communications. Reasonable assistance shall be provided upon request, if feasible.

 (c)  Incoming mail may be opened only when there is reason to suspect it contains contraband, and in the presence of the patient unless dangerous or infeasible in the light of the patient’s condition. Contraband is specific property, the possession or use of which is illegal or entails a substantial threat to the health and welfare of the patient or the hospital community.

 (d)  Whenever mail is opened on suspicion of contraband, an identification of the person opening the mail, a statement of the facts constituting good cause, and the results of the opening including disposition shall be noted in the patient’s record.

 (e)  A patient’s mail, whether incoming or outgoing, shall not be read under any circumstances, unless at the patient’s request.
6. Right to Use Telephones.

 (a)  Every patient has the right to make telephone calls at his own expense, at reasonable times, using telephones designated for patient or public use. The facility shall take steps to provide sufficient telephones.

 (b)  In cases of personal emergency, when alternative methods of communication are impractical, every patient shall have the right to make reasonable local and long distance phone calls, free of charge. These calls shall be subject to reimbursement if the patient has sufficient funds to pay for the call. The director of the facility, or his delegate, shall determine what constitutes personal emergency.

ARTICLE II
THE RIGHT TO RELIGIOUS
FREEDOM



 Statement of Principle.

 Every patient has the right to follow and practice his religion. Substantiated ethical convictions held independently of a belief in any religion shall be accorded the same respect as religious belief. The facilty shall provide reasonable assistance to enable a patient to effect this right.

 The exercise of these rights may be limited only if it poses a serious threat to the freedom or welfare of others, or a serious danger to the patient.
1. Right to Refuse Medication.

 Any patient who holds a substantiated belief in the power of spiritual healing shall not be compelled to take medication, provided the patient is intellectually capable of understanding the impact of such refusal and of deciding to refuse medication.
2. Right to Diets Based on Religious Considerations.

 The patient’s right to independently comply with his or her dietary regimen shall not be interfered with by the facility unless unfeasible or unless there is serious danger to a person’s health.
3. Right to Abstain from Religious Practices.

 No patient shall be required to be pressured directly or indirectly to participate in religious practices. No patient shall be compelled to accept visitation from a clergyman or minister of any religion.

ARTICLE III
THE RIGHT TO HANDLE
YOUR PERSONAL AFFAIRS



Statement of Principle.

 Every patient retains all civil rights not specifically curtailed by an order of a court or other body empowered to take such action.

 (a)  Every patient has the right to handle his personal affairs. Admission or commitment to a mental health facility does not by itself, prevent a patient from holding a driver’s license or professional license, from marrying or obtaining a divorce, from voting or writing a will, or exercising other civil and personal rights; nor is the patient guaranteed the ability to exercise any of these rights.

 (b)  Every patient has the right to purchase, keep, and use personal possessions. This right may be limited only when the possession or use of specific property is illegal or creates a substantial threat to the health or welfare of the patient or others. The reasons for imposing any limitations on the exercise of this right and the scope of such limitation shall be clearly explained to the patient and placed in the patient’s record.

 (c)  Every patient has the right to sell or retain any product or crop he makes, or grows on facility property. Money received from these activities shall not be used to pay the costs of any patient’s care and treatment.

 (d)  A patient shall not be deemed incompetent to manage his own affairs solely by reason of admission or commitment to a mental health facility.

 A court finding of incompetency may not be extended beyond the specific scope of the court order.

ARTICLE IV
RIGHT TO A HUMANE PHYSICAL
AND PSYCHOLOGICAL ENVIRONMENT



Statement of Principle.

 Every patient has the right to reside and be treated in a setting which preserves and promotes his physical and psychological dignity.

 (a)  Every patient has the right to be treated humanely and with consideration by all staff members. Any grossly negligent or intentional conduct of staff which causes or may cause emotional or physical harm to a patient is a violation of this right.

 (b)  Every patient has the right to assistance in developing a physical appearance which promotes a positive self image. This includes the following:

   (1)  The right to keep and wear his own clothing, unless there are reasonable grounds to believe such clothing or specific items constitute a substantial threat to the health or safety of the patient or others.

   (2)  Clothing provided by the facility shall be neat, clean, appropriate to the season and to the extent possible, consistent with the patient’s personal preference. This clothing shall enable the patient to make a customary appearance within the community.

   (3)  The right to purchase, keep, and use customary cosmetic, hygiene, and grooming articles or services unless there are reasonable grounds to believe specific articles constitute a substantial threat to the health or safety of the patient or others.

   (4)  Basic customary cosmetic, hygiene, and grooming articles or services shall be provided by the facility for patients who need them but cannot afford them. Patients shall be given reasonable assistance as needed in utilizing cosmetic, hygiene, and grooming articles and services.

 (c)  Every residential patient shall be furnished with a comfortable bed and bedding, adequate change of linen, a closet or locker for personal belongings, and a bedside cabinet. Every patient, at his or her own risk, shall be allowed to keep and display appropriate personal belongings and to add personal touches to his room or living area.

 (d)  Every patient has the right to a nutritionally adequate diet and every patient has the right to eat or to be fed under supervision, in the dining room or area in the relaxed atmosphere, and to use normal eating implements, unless contra-indicated by the patient’s conduct or course of treatment.

 (e)  Every patient has the right to bathroom facilities which provide privacy for personal hygiene and meet Departmental standards for health, safety, and cleanliness.

 (f)  Every patient has the right to therapeutic and daily living activities held in settings that approximate noninstitutional living. Dining, recreational, vocational, and other activities shall where possible and appropriate be conducted on a basis which provides interaction between male and female patients.

ARTICLE V
RIGHT TO TREATMENT



Statement of Principle.

 Every patient has the right to receive treatment designed to aid and promote his recovery from mental illness. This treatment shall, whenever possible, be in or near the patient’s home community, and shall be in the least restrictive setting available to provide adequate treatment or to meet the conditions of security imposed by a court.
1. Individual Treatment Plan.

 (a)  Every patient has the right to an individualized treatment plan, appropriate to his needs, setting forth the objectives, goals, activities, experiences, and therapies designed to promote recovery.

 (b)  The plan shall be developed within 72 hours of admission or commitment. It shall be revised whenever necessary and reviewed at least every 30 days.

 (c)  Every patient has the right to participate to the extent feasible in the development of his treatment plan. The plan shall be written in terms understandable by lay persons and shall be explained to the patient. A copy of the treatment plan shall be made available for the patient’s review.
2. Discharge.

 Every patient has the right to be discharged as soon as care and treatment is no longer necessary. Every patient has the right to all of the available treatment modalties appropriate to his or her needs which promote recovery and discharge. Treatment shall also include the appropriate post-discharge rehabilitative services available in the community.

ARTICLE VI
PERMISSIBLE SPECIALIZED AND
PROHIBITED TREATMENT PROCEDURES



Statement of Principle.

 Every patient shall only receive approved treatment procedures in accordance with Departmental regulations. This treatment shall be described in his individual treatment plan and shall be explained to the patient.
1. Permissible Procedures.

 (a)  All patients may in an emergency, be required to accept the minimal sufficient diagnostic procedures and treatment necessary to alleviate the emergency.

 (b)  Patients committed pursuant to sections 303, 304 or 305 of the act (50 P. S. § §  4303, 4304, and 4305), may also be required to accept routine medical, psychiatric, psychological, and educational programs conforming to departmental regulations and the patient’s individualized treatment plan.

 (c)  Any patient committed for examination by court may be required to accept the minimal diagnostic procedures necessary to determine the patient’s mental condition.

 (d)  Any patient in treatment on a voluntary basis may agree to participate in any and all approved treatment methods as described in his individualized treatment plan. Any voluntary patient may also refuse to participate in any aspect of his individualized treatment plan and may request a review of the proposed treatment. Refusal to accept a reviewed and approved treatment may be cause for discharge.
2. Specialized Procedures.

 (a)  No patient shall be subject to the withholding of privileges, nor to any system of rewards, except as part of an individualized treatment plan.

 (b)  Electro-convulsive or other therapy, experimental treatments involving any risk to the patient, or aversion therapy shall not be prescribed unless:

   (1)  The patient’s treatment team has documented in the patient’s record that all reasonable and less intensive treatment modalities have been considered; that the treatment represents the most effective therapy for the patient at that time; and that the patient has been given a full explanation of the nature and duration of the proposed treatment and why the treatment team is recommending the treatment; and that the patient has been told that he or she has the right to accept or refuse the proposed treatment and that if he consents, has the right to revoke his consent for any reason at any time prior to or between treatments.

   (2)  The treatment was recommended by qualified staff members trained and experienced in the treatment procedure and has been approved by the facility administrator if an M.D. or, if not, by the clinical director after review by the appropriate committee.

   (3)  The patient has given written informed consent to the specific proposed treatment. In the alternative, oral informed consent is sufficient where that consent is witnessed by two persons not part of the patient’s treatment team. In either case, such consent shall be limited to a specified number of maximum treatments over a specific period of time and shall be revocable at any time before or between treatments. Such withdrawal of consent may be immediately effective.

   (4)  If a patient’s treatment team determines that the patient could benefit from one of those specified treatments but also believes that the patient does not have the capacity to give informed consent to the treatment, a court order shall be obtained authorizing the recommended treatment before such treatment may be administered to the patient.

 (c)  No patient shall be subject to chemical, physical, or psychological restraints, including seclusion, other than in accordance to the Department’s regulations applicable to State Mental Health Facilities or, in case of community facilities, the policy and procedures for seclusion and restraint approved by its medical staff and governing body. A copy of the applicable regulations shall be made available to patients upon request.

 (d)  No patient shall be the subject of any research, unless conducted in strict compliance with Federal regulations on the protection of human subjects. Patients considered for research approved by the facility shall receive and understand a full explanation of the nature of the research, the expected benefit, and the potential risk involved. Copies of the Federal regulations shall be made available to patients involved in, or considering becoming involved in, research or their advocates. Patient research conducted in State facilities or funded by State monies requires prior approval of the Deputy Secretary of Mental Health.
3. Prohibited Procedures.

 Psychosurgery, removal of organs for the purpose of transplantation, and sterilization, shall not be performed at a State-operated mental hospital.

ARTICLE VII
GRIEVANCE AND APPEAL
PROCEDURES



Statement of Principle.

 To insure that these rights are safeguarded and that disputes concerning their rights and others are resolved promptly and fairly, patients must have the right to lodge grievances and appeals when informal methods of resolving disputes are unsuccessful. Each facility shall have a grievance and appeal system in effect. Every patient shall be informed of the grievance and appeal system and shall be encouraged to utilize it when informal methods of resolving complaints are unsuccessful.
1. Grievance Procedure.

 (a)  Any patient, or those helping him, may initiate a complaint orally or in writing, concerning the exercise of these rights or the quality of services and treatment at the facility. The complaint shall be presented as soon as possible to the treatment team leader or other appropriate person.

 (b)  Every patient shall have the right to the assistance of an independent person and witnesses in presenting his complaint.

 (c)  The treatment team leader, administrative supervisor, or their designees receiving the complaint shall investigate the complaint and make every effort to resolve it. Based upon this investigation, a decision shall be rendered in writing as soon as possible but within 48 hours after the filing of the complaint. Complaints shall be decided by persons not directly involved in the circumstances leading to the grievance.

 (d)  The patient shall be given a copy of the complaint and final decision and a copy shall be filed in the patient’s record.
2. First Level Appeal.

 (a)  Any patient, or those helping him, may appeal the grievance decision within 10 working days of the decision. State-operated facilities shall follow the procedures set forth in this part. Non-State operated facilities shall have in effect a fair and impartial appeal procedure, which shall be reviewed by the county administrator.

 (b)  In a State-operated facility, standing Rights Review Committee composed equally of facility staff and persons from the community not affiliated with the facility shall hear the appeal and render a written decision within 10 working days of the date of the appeal. Staff members shall be appointed by the facility director. Until such time as the committee is in effect, the appeal shall be heard by a hearing examiner appointed by the regional deputy secretary. If the grievance requires immediate action, the appeal shall be heard and decided as soon as possible.

 (c)  The patient shall be given prompt notice of the date set for the appeal and shall be informed of his right to be represented by counsel.

 (d)  Hearings shall be informal, without strict adherence to the rules of evidence. A sufficient record of the hearing shall be made.

 (e)  A copy of the decision shall be given to the patient, the facility director, and filed in the patient’s chart.
3. Second Level Appeal.

 (a)  Any patient in a State facility, those helping him, or the facility director, may appeal the decision of the hearing examiner or Rights Review Committee within 10 working days of the decision. The appeal must set forth the specific objections to the decision.

 (b)  The Secretary of Public Welfare shall establish a standing Rights Appeal Committee composed equally of Department and community personnel. Within 5 working days of receipt of a second level request, the Committee shall review the decision of the Rights Review Committee and may seek any additional information it deems necessary.

 (c)  The patient shall be given prompt notice of the date set for the appeal and shall be informed of his or her right to be represented by counsel.

 (d)  Reviews shall be informal. A sufficient record of the hearing shall be made.

 (e)  The Committee shall submit a recommendation to the Secretary of Public Welfare within 10 working days of its receipt of the second level appeal request. The Secretary will review the findings and recommendations by the Committee and will issue a decision.

 (f)  Nothing in this section shall be construed as precluding a patient from instituting appropriate legal proceedings.

Cross References

   This section cited in 55 Pa. Code §  5100.4 (relating to scope); 55 Pa. Code §  5100.52 (relating to statement of principle); 55 Pa. Code §  5200.47 (relating to other applicable regulations); 55 Pa. Code §  5210.56 (relating to other applicable regulations); 55 Pa. Code §  5320.22 (relating to governing body); and 55 Pa. Code §  5320.45 (relating to staff orientation and training).



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