D.10 RIGHTS AND RESPONSIBILITIES OF PATIENTS2.pdf

D.10 RIGHTS AND RESPONSIBILITIES OF PATIENTS

36C25922R0102

RIGHTS AND RESPONSIBILITIES OF PATIENTS

MCP 00-45

Oklahoma City VA Medical Center Oklahoma City, OK. 73104

Signatory Authority:

Wade Vlosich Medical Center Director

Responsible Owner:

Medical Center Director

1. POLICY

Rescinded Document:

CM 11-56, Rights and Responsibilities of Patients, August 23, 2017

Effective Date:

December 28, 2022

Recertification Date:

December 31, 2027

To provide policy and procedure regarding patient rights and responsibilities at this facility.

2. JUSTIFICATION

The Department of Veterans Affairs and the Oklahoma City VA Health Care System are committed to providing high quality medical care in a climate where the human needs and concerns of the patients are met and where individual interests are protected. This climate must be based on respect for the dignity of the patient as an individual and on care, which is provided in a courteous, concerned, and compassionate manner. In order to achieve these goals, the dedication of each employee to the principles outlined in this document is essential. It is only through the willing assumption of this responsibility on the part of the staff that this health care facility will be able to provide the kind of patient care to which it is committed. Patient care is based on health care needs. The same standard of care is given equally to all patients who are treated in this facility. Patients and their family members will not be subject to discrimination for any reason, including for reasons of age, race, ethnicity, religion, culture, language, physical or mental disability, socioeconomic status, sex, sexual orientation, or gender identity or expression. The Health Care System has the right to expect reasonable and responsible behavior on the part of the patient, their relatives, and friends.

3. RESPONSIBILITIES

a. The Health Care System Director will be responsible to ensure that all patients are informed of their rights and responsibilities as stated in this policy.

b. The Chief of Staff will be responsible to ensure that all patients are informed of their rights and responsibilities as stated in this policy.

c. Service Chiefs will be responsible to inform all employees under their scope of supervision on the content of this policy and will also ensure that their employees comply with the principles stated hereby.

December 28, 2022 MCP 00-45

d. The Ethics Committee will be responsible to oversee that the implementation of this policy by all concerned, according to VA regulations.

e. All employees will be responsible for compliance with the principles and procedures stated in this policy.

4. OTHER PARAGRAPHS

a. Posters displaying Patients’ Rights and Responsibilities will be located in various areas of the medical center where patients and employees can easily view them.

b. Every Health Care System patient has the following rights:

(1) Access to Care: Eligible patients will be accorded impartial access to care and/or accommodations that are available or medically indicated. The patient has the right to a reasonable medical center response to his/her requests and needs for treatment or service, which is consistent with the medical center capacity, capability, and resources, as well as the medical center mission. If for any reason the medical center cannot meet the patient’s request for care, every effort will be made to find alternative treatment sources. In some cases this will include timely transfer to other VA medical centers when medically permissible, provided the transfer is acceptable to the other treatment facility.

(2) Respect and Dignity: the patient has the right to considerate, respectful care at all times with reasonable protection from harm and under all circumstance with recognition of his/her personal dignity. The right to considerate and respectful care includes the following:

(a) Consideration of the psychosocial, spiritual, and cultural variables pertinent to the patient’s perception of illness. Patients will be allowed and supported in their full expression of cultural and/or spiritual practices that do not harm others or interfere with the planned courses of medical treatment.

(b) The dying patient has the right to expect care that optimizes comfort and dignity by treating symptoms whenever possible, as desired by the patient or his/her decision-maker. The dying patient has a right to appropriate and aggressive pain management.

The dying patient and his/her family have the right to expect medical center staff to acknowledge the psychosocial and spiritual concerns regarding dying and the expression of grief by the patient and his/her family.

(c) Each and every patient has the right to access protective services.

(3) The right of the patient to make decisions about his/her health care: The patient or his/her surrogate decision-maker will be included in the planning of care in order to incorporate patient preferences in treatment decisions, whenever possible. This includes the following:

(a) Refusal of Treatment: The patient has the right to accept medical care or refuse treatment to the extent permitted by law, as well as the right to be informed of the medical consequences of refusal.

(b) Advance Directives: Patients will be given the opportunity to initiate an advance directive and appoint a surrogate decision-maker to make health care decisions on his/her behalf to the extent permitted by law. Under no circumstances will the provision of care be conditioned by the existence of an advance directive.

(4) Right to Information:

(a) The patient has the right to have information to make treatment decisions that are consistent with his/her wishes. Pertinent information will include the potential benefits and risks of proposed treatment, problems related to recuperation, the likelihood of successful outcome, the possible results of non-treatment, information regarding significant alternative treatment(s) and information about pain and pain relief measures. Patients have the right to know the name of their primary care provider as well as the identity and professional status of individuals who are responsible for authorizing and performing procedures or treatments. This information will include the existence of any professional relationship to another health care provider or institution that might suggest conflict of interest.

(b) Cultural sensitivity and effective communication are necessary for treatment purposes. This includes access to interpreters for sign and foreign language. Requests for Non-English and American Sign Language interpreter services during normal business hours, 8:00 a.m. to 4:30 p.m. Monday through Friday, will be coordinated through the EEO Program Manager. EEO Manager cell phone number 405-365-5163 and office number is 405-456-3364. Request for Non-English and American Sign Language interpreter services after normal business hours, weekends or holidays, will be coordinated through the Medical Administrative Officer (MAO) of the day. (Center Memorandum 00EE-7)

(c) Patients will receive information about the costs of their care, if any, before they are treated. Patients are responsible for paying their portion of the costs associated with their care.

(d) Patients will be informed of any injuries caused by their medical care. Patients will be informed how to request compensation for injuries.

(5) Patient Rights Policy and Patient Complaint Process: The patient has the right to obtain understandable information at the time of admission regarding the Health Care System’s patient rights and responsibilities. Patients are entitled to information about the medical center’s mechanism for the initiation, review, and resolution of patient complaints. A patient has the right to present a grievance/complaint, if he/she feels any of his/her rights have not been provided. These grievances/complaints can be brought forth without fear of retaliation and without fear that doing so will compromise medical treatment or benefits.

(6) Ethical Issues and Conflict Resolution in Care or Treatment Decisions: The patient or his/her surrogate decision-maker has the right to participate in the consideration of ethical issues that arise in the course of care, including issues of conflict resolution, withholding resuscitative services, forgoing or withdrawal of life-sustaining treatment, and participation in investigational studies or clinical trials.

Unresolved issues may be referred to the Ethics Committee.

(7) Management of Pain: The patient can expect to be involved in making care decisions, including managing pain effectively. The patient can expect the following:

information about pain and pain relief measures, a concerned staff committed to pain prevention; health professionals who respond quickly to reports of pain; and state of the art pain management.

(8) Experimentation and Research Projects: The patient has the right to be informed of any experimentation, research, or education projects which may affect the patient’s care or treatment. All patients asked to participate in research project will be given a description of the expected benefits, potential discomforts and risks, and alternative services that might also prove advantageous to them. Patients will be given a full explanation of the procedures to be followed, especially those that are experimental in nature. Patients may refuse to participate in a research project and refusal will not compromise access to services.

(9) Personal Privacy and Confidentiality of Information:

(a) The patient has the right to be interviewed, examined, and treated in surroundings designed to give reasonable visual/auditory privacy. Patient information will be provided only to those involved in the patient's direct care or those who have a legal right to the information. A patient has the right to request another room, if another patient or a visitor in the room is unreasonably disturbing, and will be transferred when another room equally suitable for his/her care needs is available.

(b) The patient and/or the patient’s legally designated surrogate decision maker has the right to have access to the information contained in the patient’s medical record, within the limits and specific provisions of applicable law.

(c) The patient’s guardian, next of kin, legally appointed surrogate decision-maker, or other legally authorized responsible person has the right to exercise, to the extent permitted by law, the rights delineated on behalf of the patient if the patient has been adjudicated incompetent in accordance with law, is found by his/her physician to be medically incapable of understanding the proposed treatment or procedure, or is unable to communicate his/her wishes regarding treatment.

(d) Confidential Communications: It is VA’s policy that all patients have a right to receive written communication or correspondence pertaining to health information in a confidential manner by alternative means or at an alternative location other than the patient’s permanent address of record. Once the veteran requests this service, all future correspondence and communications will be sent to the alternative address. In addition, the veteran must specify a start date for use of the confidential address and may also request a date when the use of this address should end.

(10) Restraint and Seclusion of Patient: Each patient has the right to be free from physical restraint or seclusion except when there is substantial risk of imminent harm by the patient to self, or others, and less restrictive means of preventing such harm have been determined to be inappropriate or insufficient. Restraint or seclusion may not be used as a punishment, for the convenience of staff, or as a substitute for treatment programs. (Center Memorandum 11-19)

(11) Unless medically contraindicated, the following Bill of Rights is assured to each patient:

(a) The right to receive, to the extent of eligibility under the law, prompt and appropriate treatment for any physical or emotional disability or disabilities in the least restrictive environment necessary for that treatment, and free from unnecessary or excessive medication.

(b) The patient will not be denied his/her legal rights while hospitalized (except where state law provides otherwise).

(c) Each patient has the right to communicate via (visitors, mail, telephone calls, and access to language interpreters) unless restrictions are applied for the patient’s wellbeing. NOTE: The treating physician will document clinical justification of restrictions in the medical record.

1. When it is the treating team’s opinion that a form of communication may affect the patient’s medical care (cause injury or deterioration), damage the environment, or cause infringement on the rights of others, the physician will discuss the restriction(s) with the patient and/or family. The discussion will be documented in progress notes and orders will be appropriately written in the Doctor’s Orders.

2. The mental health staff will be consulted to render their opinion of the restriction with the patient and/or family; the discussion will be documented in the progress notes; and orders will be written.

3. The patient’s condition and the form of communication will be monitored to assure that the patient’s rights will not be violated if the restrictions no longer apply.

(d) The patient has the right to purchase writing materials and, if necessary, receive help in writing, reading, or sending mail.

(e) The right to wear his/her own clothes, except where restricted by fire and safety regulations, or if it interferes with treatment.

(f) The right to keep their own personal possessions consistent with security and available space, subjected to fire safety regulations, restrictions on noise, and possession of contraband material, drugs, and medications. Patients are urged to send valuables home with family or trusted friends.

(g) The right to keep and spend their own money or deposit individual personal funds with the Agent Cashier in accordance with the Department of Veterans Affairs.

Patients are urged to keep no more than $10 in their possession while hospitalized.

(h) The right to socially interact with others, exercise regularly, and have the opportunity for religious worship.

d. Patient Responsibilities:

(1) The patient has the responsibility to provide, to the best of his/her knowledge, accurate and complete information about present complaints, past illnesses, hospitalization, medications, and other matters relating to his/her health. The patient has the responsibility to report unexpected changes in his/her condition to the responsible practitioner. A patient is responsible for making it known whether he/she clearly comprehends a contemplated course of action.

(2) The patient is responsible for following the treatment plan recommended by the practitioners. This may include following the instructions of nurses and allied health personnel as they carry out the coordinated plan of care, implement the responsible practitioner’s orders, and enforce the applicable hospital rules and regulations. The patient is responsible for keeping appointments and notifying the hospital if unable to do so.

(3) The patient is responsible for accepting responsibility for his/her actions if he/she refuses treatment. This includes discussing questions or any disagreement that he/she may have about the treatment plan with the treatment staff.

(4) The patient is responsible for following hospital rules and regulations affecting patient care and conduct. The patient is responsible for being respectful of the property of other persons and of the hospital. Patients’ responsibilities include their assistance in the control of noise.

(5) The patient is expected to ask the team what to expect regarding pain and pain management. The patient should discuss pain relief options with the team and work with them to develop a pain management plan. They should ask for pain relief when pain first begins and assist the team with the measurement of pain. They need to advise the team if pain is not relieved.

(6) In order to provide a safe treatment environment for all patients, the patient has the responsibility to respect other patients and staff and follow the facility’s rules. The patient should avoid unsafe acts, such as getting out of bed without assistance, taking unfamiliar medications or agreeing to a course of action not understood or requested.

The patient should avoid any action that places others at risk for accidents or injuries.

The patient should immediately report any condition believed to be unsafe.

5. REFERENCES

http://www.ethics.va.gov/docs/policy/Pt_CLC_Rights_and_Responsibilities_20130207.p df

6. RESCISSION

CM 11-56, Rights and Responsibilities of Patients, August 23, 2017, is rescinded.

7. REVIEW

Required review at minimum during recertification and including when there are changes to the governing document.

8. RECERTIFICATION

This MCP is scheduled for recertification on or before the last working day of December 31 – 5 years from effective date. This MCP will continue to serve as local policy until it is recertified or rescinded. In the event of contradiction with national policy, the national policy supersedes and controls.

9. SIGNATORY AUTHORITY

Wade Vlosich Oklahoma City VA Medical Center Director Date Approved: December 28, 2022

NOTE: The signature remains valid until rescinded by an appropriate administrative action.

DISTRIBUTION: Medical Center Memorandums - By Service (sharepoint.com) http://www.ethics.va.gov/docs/policy/Pt_CLC_Rights_and_Responsibilities_20130207.pdf http://www.ethics.va.gov/docs/policy/Pt_CLC_Rights_and_Responsibilities_20130207.pdf https://dvagov.sharepoint.com/sites/OKL/Memos/Lists/Center%20Memorandums/ByService.aspx