Here are some more rights as patients. Doctors can not deny you treatment.
The health care rights of patients have been the subject of much public debate and legislative action in the latter half of the 20th century. The fundamental right to quality medical care and compensation for medical malpractice, the right to informed consent, and the right to health care privacy, are all protected under United States congressional law. While these and other laws ensure many rights for medical patients, the changing nature of medical knowledge and care also ensures the continued need to regulate the relationships among patients, care-givers, and care-giving institutions. But quite apart fromany legal issues, the recognition that patients have rights can transform thedoctor-patient relationship from an authoritative and paternalistic one intoa true partnership, with the result that the quality of medical care is enhanced.
Among one's rights as a patient is the right to make decisions about the course of treatment received, as well as to know about all reasonable alternativetreatments. One also has the right, as a competent adult, to refuse any proposed treatment, even if doing so may mean that one will become sicker or evendie.
No medical provider can treat or even touch a prospective patient until thatperson has made a voluntary decision to accept treatment; such a decision isreferred to as informed consent. In order to help the patient decide whetherto provide this consent, the physician is obligated to provide at least the following information:
Descriptions of the recommended treatment or procedure and the associated risks and benefits, with special emphasis on the risk of death or serious disability.
Descriptions of alternative treatments and procedures, and the associated risks.
The likely results iftreatment is refused.
The probability (and definition) of success.
Any major problems anticipated in recuperation, including the expectedlength of time before normal activities can be resumed.
Any information usually provided to patients in the same or similar situation, such as thepercentage of the treatment that the patient's health plan will cover.
A key ingredient in the concept of informed consent is that the consent mustbe voluntary. This means the patient must not be overly medicated, intoxicated, under threat by the physician, or under extreme duress. As long as the patient understands the information needed to give an informed consent for a proposed treatment, the patient is considered competent to make the decision. The only way anyone can take away a patient's right to provide informed consentis by having the patient declared incompetent, and this must be done in a courtroom.
Although very few treatments actually require a patient to sign a consent form (the most common exception being when a patient agrees to be a research subject), doctors and hospitals usually ask the patient to sign forms consentingto treatment. In order to be useful as evidence of the patient's informed consent, the written form must describe the proposed procedure, the risks and benefits associated with the procedure, any alternative procedures and their risks, the risks of nontreatment, success rates, and any problems anticipatedin recuperating from the procedure. A patient may add new requirements or cross out points disagreed with on the form, although the treating physician maythen be unwilling to perform the procedure if he or she fees that the limitations the patient is adding to the consent form are too strict to allow the procedure to be conducted safely.
The patient can withdraw his or her consent at any time before treatment. Todo so, the patient should first inform the treating physician of the decision. Then the patient should either obtain and destroy the original consent form, or prepare a non-consent form with the date and time of day that consent iswithdrawn.
A patient's rights in situations of medical emergency are also well defined.Emergencies are defined as any medical conditions that are likely to result in death, disability, or serious illness if not attended to very quickly. If an individual is in medical emergency or in labor, any hospital with emergencyfacilities must treat that person if it can. If it cannot, it must refer theindividual elsewhere.
If the hospital emergency department determines that a patient is in medicalemergency, the law and medical ethics requires that a physician provide treatment or find someone who can. Conditions that require the immediate attentionof a doctor include
Severe head injuries
Sudden and complete changes in personality
In most states, the patient has a right to see and copy his or her medical records. The patient may need this information to decide on treatment, to determine when and if to change physicians or health plans, and to prepare for thefuture. It is inappropriate for a patient's medical records to contain personal criticisms, such as "This patient is an alcoholic." Such statements unfairly color the attitudes of others who read the records, and they can lead tohealth providers concealing records from the patient out of fear of embarrassing the person who wrote the remarks. Although physicians and health care facilities can charge the patient a reasonable fee for making a copy of the patient's medical records, this fee should not exceed the actual cost of duplication.
All health care providers have a legal and ethical duty to maintain the confidentiality of a patient's records. The Hippocratic Oath, the American MedicalAssociation Principles of Ethics, and the American Nurses Association Code all recognize the need to safeguard patient confidences. Nevertheless, it is not realistic to expect that all medical records will remain secret. Even on aneed-to-know basis, many individuals will have access to a patient's medicalrecords. For this reason, it is important that extremely sensitive information about the patient be safeguarded. In a hospital setting, such informationas a psychiatric or HIV diagnosis could rapidly spread and damage the way thestaff treats the patient. Such information, if leaked, could also affect thepatient's ability to obtain housing, employment, and insurance. A doctor's violation of patient confidentiality could be grounds for a malpractice suit,if the breach caused harm to the patient.
One of the first comprehensive statements of a patient's rights was drafted by the American Hospital Association in 1973. Today it must be posted in the corridors of every hospital facility the association has accredited and includes twelve basic rights:
1. A patient has the right to considerate and respectful care.
2. A patient has the right to receive complete information from a physician about a patient's diagnosis, treatment plan, and prognosis.
3. A patient has the right to obtain information about the specific nature ofa proposed treatment or procedure, a disclosure of the risks involved, and information about medical alternatives.
4. A patient has the right to refuse treatment and to be informed of the medical consequences.
5. A patient has the right to privacy during discussion of one's medical condition and while undergoing medical care.
6. A patient has the right to expect all records related to medical care willbe kept confidential.
7. A patient has the right to expect that reasonable efforts will be made torespond to the patient's request for services, and that the patient will notbe transferred to another medical facility without advising the patient of the need to be transferred and without ensuring that the new facility will accept transfer of the patient.
7. A patient has the right to obtain information about the relationships amongst care providers in the hospital and related medical and educational institutions. This is designed to protect patients from conflicting interests thatmight affect quality of care.
8. A patient has the right to obtain information about human experimentationand research that might affect treatment or care, and to refuse to take partin such experimentation and research.
9. A patient has the right to expect reasonable continuity of care. This is meant to assure the patient that, for example, diagnoses will be followed up with continued treatment.
10. A patient has the right to examine and receive an explanation of the hospital bill.
11. A patient has the right to be informed of hospital rules and regulationsthat apply to patient conduct. This statement of rights provides benefit to both patient and hospital.
12. Though the quality of resolution varies widely, most hospitals have grievance committees that will hear complaints and staff representatives that actas patient advocates when a right is called into question.
Since the Hospital Patients Bill of Rights was drafted in 1973, a number of important laws related to patient's rights have been enacted by state and federal government. The Nursing Home Reform Act, passed by Congress in 1987 and put into effect in 1990, guarantees the standard of care in nursing home facilities, regulating aspects of care such as the provision of nutritious food, the respectful and courteous treatment of patients, and the quality of rehabilitation services. The Federal Emergency Medical Treatment and Active Labor Act of 1989, and similar state laws, protect patients who are in need of emergency care from being turned away from a hospital emergency room and or being denied treatment. In 1991, Congress passed the Patient Self-Determination Act,providing greater personal control over the medical care given at the end oflife. The Federal Privacy Act of 1974 provided loose guarantees of protection for medical records. More recently additional laws have been passed to ensure the confidentiality of medical records. Bills to guarantee patients rightsin Health Maintenance Organizations were under congressional review as the calendar year 1999 drew to a close. As the 21st century is approached and medical procedures become more complex and costly, as infectious diseases and genetic conditions become easier to diagnose, and the ability to sustain and prolong life continues to improve, the need for new legislation will be even more pressing.
Your Rights as a Client or Patient
of the Connecticut Department of Mental Health & Addiction Services
Thomas A. Kirk, Ph.D., Commissioner
Patricia S. Rehmer, MSN, Deputy Commissioner Peter B. Rockholz, MSSW, Deputy
You are entitled to be treated in a humane and dignified way at all times, and with full respect to:
. Personal Dignity . Right to Privacy . Right to Personal Property . Civil Rights
You have the right to freedom from physical or mental abuse or harm; You have the right to a written treatment plan that is
developed with your input and suited to your own personal needs, goals and aspirations; You should be informed of your rights by the
institution, agency or program. In addition, a list of your rights must be posted on each ward of a hospital.
Other rights you have include:
Humane and dignified treatment: You have the right to receive humane
and dignified treatment at all times and with full respect to your personal
dignity and privacy. A specialized treatment plan shall be developed in
accordance with your needs. Any treatment plan shall include, but not be
limited to, reasonable notice of discharge, your active participation in and
planning for appropriate aftercare. (See CGS 17a-542)
Personal Dignity: While in an inpatient facility, you have the right to wear
your own clothing, to maintain your own personal belongings (given
reasonable space limitations) and to be able to have access to and spend
your own money for personal purchases.* Except for patients in Whiting
Forensic Division, you have the right to be present during any search of
your personal belongings. Any exception to these rights must be explained
in writing and made a part of your clinical record. (See CGS 17a-548)
Privacy & Confidentiality: You have the right to privacy &
confidentiality. Records that would identify your person, manner of
treatment or your diagnosis cannot be given to any other person or agency
without your written consent. All records maintained by the courts [as they
relate to a recipientís treatment] shall be sealed and available only to
respondent or counsel.* No person, hospital, treatment facility nor DMHAS
may disclose or permit the disclosure of the identity, diagnosis, prognosis or
treatment of any service recipient that would constitute a violation of state
or federal statutes concerning confidentiality.*
(See CGS 17a-500, 17a-688, 52-146f and 42 CFR part 2)
Physicianís Emergency Certificate & Commitment: You, your advocate
or counsel, can find out more about what Commitment procedures apply by
reviewing the appropriate statutes. All persons admitted through a
Physicianís Emergency Certificate have the right, upon request, to a
Probable Cause hearing within 3 business days from admission. All
voluntarily admitted patients shall be informed, upon admission, of their
ability to leave after three days notice. Any voluntarily confined patient
shall not be denied his or her request to leave within three days notice in
writing unless an application for commitment has been filed in a court of
competent jurisdiction. Different statutes apply depending on your
placement in addictions treatment or for a psychiatric disorder.
(See CGS 17a-495 et seq.; 17a-502; 17a-506; 17a-682 to 17a-685, 54-56d)
Visiting and Communication Rights: You may receive visitors during
scheduled visiting hours. You have the right to visit with and may have
private conversations with clergy, attorneys or paralegals of your choice at
any reasonable hour. Facilities may reasonably maintain rules regulating
visitors. Mail or other communications to or from a service recipient in any
treatment facility may not be intercepted, read or censored.* Any
exceptions to rights regarding communications must be explained in
writing, signed by the head of the facility (or designee) and made a part of
your clinical record. (See CGS 17a-546, 17a-547)
Access to Your Medical Record: You or your attorney may have the
right, upon written request, to inspect your hospital records. Unless your
request is made in connection with litigation, a facility may refuse to
disclose any portion of the record which the mental health facility has
determined would create a substantial risk that you would inflict a life
threatening injury to self or others, experience a severe deterioration in
mental state,* or would constitute an invasion of privacy of another.
(See CGS 17a-548, 52-146f)
Other Rights may be guaranteed by state or federal statute, regulation or
policies which have not been identified in this list. You are encouraged to
seek counsel to learn of or to better understand these laws and policies.
Restraint & Seclusion: If conditions are such that you are restrained or
placed in seclusion, you must be treated in a humane and dignified manner.
The use of involuntary seclusion or mechanical restraints is allowed only
when there is an imminent danger to yourself or others. Documentation of
reasons for these interventions must be placed in your clinical records
within 24 hours. Medications cannot be used as a substitute for a more
appropriate treatment. (See CGS 17a-544)
Remedies of Aggrieved Persons: If you have been aggrieved by a
violation of sections 17a-540 to 17a-549 you may petition the Superior
Court within whose jurisdiction you reside for appropriate relief.
(See CGS 17a-550)
Disclosure of Your Rights: A copy of your rights shall be prominently
posted in each ward where mental health services are provided.
(See CGS 17a-548)
Medication, Treatment, Informed Consent & Surgical Procedures:
You, your advocate or counsel, can find out more about what procedures
apply by reviewing the appropriate statutes (see CGS 17a-543a-j). If you
have been hospitalized under any sections of 17a-540 to 550, you shall
receive a physical examination within 5 days of admission and at least once
every year thereafter. Reports of such exams must be entered into your
clinical record. (See CGS 17a-545). No medical or surgical procedures, no
psychosurgery or shock therapy shall be administered to any patient without
such patientís written informed consent, except as provided by statute.* A
facility may establish a procedure that governs involuntary medication
treatments but any such decision shall be made by someone not employed
by the treating facility and not until the patientís advocate has had
reasonable opportunity to discuss such with the facility.* If a facility had
determined to administer involuntary medication pursuant to statute, the
patient may petition the Probate Court to hold a hearing to decide whether
to allow this intervention. Notwithstanding the provisions of this section
(17a-540 to 550) if obtaining consent would cause a medically harmful
delay, emergency treatment may be provided without consent.
(See CGS 17a-543a-f)
Denial of Employment, Housing, Etceteras: You cannot be denied
employment, housing, civil service rank any license or permit (including a
professional license) or any other civil or legal right, solely because of a
present or past history of a mental disorder, unless otherwise provided.*
(See CGS 17a-549)
Filing of Grievances: Recipients of DMHAS facilities or programs have
the right to file a grievance if any staff or facility has: 1) violated a right
provided by statute, regulation or policy; 2) if you have been treated in an
arbitrary or unreasonable manner; 3) denied services authorized by a
treatment plan due to negligence, discrimination ...or other improper
reasons; 4) engaged in coercion to improperly limit your treatment choices;
5) unreasonably failed to intervene when your rights have been jeopardized
in a setting controlled by the facility or DMHAS; or 6) failed to treat you in
a humane or dignified manner. (See CGS 17a-451-t[1-6])
Many of the rights of service recipients in facilities in Connecticut are specified in sections 17a-540 through 17a-550 of the
Connecticut General Statutes. There may also be other rights provided by other state and federal statutes as well as by case law, but the
ones identified in 17a-540 through 17a-550 are specifically protected and must be adhered to by inpatient or outpatient facilities in
Connecticut. These statutes apply to both voluntary and involuntary service recipients, unless otherwise provided.
In general, both public and private facilities are prohibited from depriving you of any of your personal, property or civil rights.
These include the right to vote, to hold or convey property and contract, except in accordance with due process of law and unless you have
been declared incapable pursuant to sections 45a-644 to 45a-662. Any finding of incapability should specifically state which civil or personal
rights you are incapable of exercising.
For more information about your rights as a recipient of substance abuse
or mental health services in Connecticut, contact 1-800-446-7348.
*There may be exceptions and limitations to some rights. Your rights are detailed in the Connecticut General Statutes, sections 17a-450 et seq.; 17a-540 et seq.;
17a-680 et seq.; 52-146d-j; 54-56d; in Federal regulation 42 CFR part 2, the Rehabilitation Act, the Americans with Disabilities Act; in the Patientsí Self-Determination
Act, in Section 1983 and in other parts of state and federal law.
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