D18 VA MEDICAL CENTER MEMORANDUM B-136-21.docx

DEPARTMENT OF VETERANS AFFAIRS

VETERANS HEALTH ADMINISTRATION

G.V. (SONNY) MONTGOMERY VA MEDICAL CENTER

Medical Center Policy Number: B-136-21 March 15, 2012

Veteran/Resident Rights and Responsibilities

I. PURPOSE: To describe the rights and responsibilities of Veterans/residents and to prescribe rules and regulations to promote good conduct on the part of Veterans/residents at this medical center. The provisions of this policy are also applicable to Veterans/residents receiving hospital or nursing home care through Department of Veterans Affairs (VA) or private facilities as beneficiaries of VA.

II. POLICY: It is the policy of this medical center to ensure efficient and effective clinic management; to ensure quality care for Veterans in a timely manner; to ensure all beneficiaries scheduled for examination and/or treatment are scheduled and processed through the VISTA system for control and clinic workload credit; and to ensure nationally and locally established customer service standards are met. Business rules as outline in VHA Directive, 2006-055, dated 10/11/2006, VHA Outpatients Scheduling Processes and Procedures, will be instituted. The hospital prohibits discrimination based on age, race, ethnicity, religion, culture, language, physical or mental disability, socioeconomic status, sex, sexual orientation, and gender identity or expression

III. DEFINITION: Family - a group of two or more persons united by blood, or adoptive, marital, domestic partnership, or other legal ties. The family may also be a person or persons not legally related to the individual (such as significant other, friend or caregiver) whom the individual considers to be family. A family member may be the surrogate decision-maker, as defined in VHA Handbook 1004.02, if authorized to make care decisions for the individual, should he or she lose decision-making capacity or choose to delegate decision making to another.

IV. RESPONSIBILITY:

A. Center Director: Establishes local policies and procedures for Veterans/residents to achieve full benefits from the treatment being offered.

B. Chief, Medical Administration Service (MAS): Ensures that each patient/resident is provided access to the medical center Veterant guide that contains the rights and responsibilities of Veterans/residents.

C. Treating Provider:

1. Ensures there is free and open communication between the Veteran and treatment team, and that Veteran's rights insofar as clinical care is concerned, are observed and protected, and takes corrective action when necessary, in accordance with VA policies. As a federal institution, clinicians employed by the G.V. (Sonny) Montgomery VA Medical Center (VAMC) have no financial incentive to increase or decrease the treatments and/or services needed to provide quality Veteran care. Clinical decisions including tests, treatments, and other interventions are based on identified Veteran health care needs. Under no circumstances are clinical healthcare decisions used to provide practitioner incentives, pharmaceutical incentives, research incentives, and other reimbursement incentives for the medical center or any of its employees.

2. Will place an individualized Veteran limitation order in the medical record when visitation, in general, or by a specific individual or individuals is medically or therapeutically contraindicated. The progress notes in the Veteran’s chart will reflect the provider’s rationale for this order.

D. Program Supervisors: Enforce policies delineated herein, including communication to subordinates, and initiate corrective action should policies not be followed.

E. Unit Staff

1. Allows a family member, friend or other individual to be present with the Veteran for emotional support during the course of stay.

2. Allows for the presence of a support individual of the Veteran's choice, unless the individual's presence infringes on others' rights or safety, or is medically or therapeutically contraindicated, as noted in the Veteran record by the attending physician/ provider.

F. Medical Center Employees: Knows and respect the rights of Veterans/residents and participate in the disciplinary control of Veterans/residents.

V. PROCEDURES:

A. Veterans'/Residents' Rights:

1. Each Veteran/resident has the right to make decisions about his or her care, treatment and services, and to involve the Veteran's family in care, treatment, and services decisions to the extent permitted by the Veteran or surrogate decision-maker. The individual may or may not be the Veteran's surrogate decision-maker or legally authorized representative.

2. Each Veteran/resident should be treated with dignity as an individual with considerate and compassionate care that respects his/her personal value and belief systems, with reasonable protection from harm, and with visual and auditory privacy.

3. Each Veteran/resident will be afforded reasonable access to care, and receive prompt and appropriate treatment for physical or emotional disorders and disabilities, in the least restrictive environment necessary for the treatment, free from unnecessary or excessive medication.

4. Each Veteran/resident will not be denied his/her legal rights while hospitalized (except where state law provides otherwise).

5. Each Veteran/resident has the right to communicate freely and privately with persons outside the facility and to have or refuse visitors. There shall be reasonable access to public telephones for making and receiving calls. The hospital allows a family member, friend, or other individual to be present with the Veteran for emotional support during the course of stay

6. Each Veteran/resident has the right to receive unopened mail. Contraband items received will be delivered to the Chief, Police Service in exchange for a receipt for determination as to further disposition.

7. Each Veteran/resident will be afforded the opportunity to write letters and be assisted in doing so, when necessary.

8. Each Veteran/ resident may be allowed to wear his/her clothes and keep personal possessions barring any medical or safety-related factors that dictate otherwise. At the time of admission, the Veteran will be advised by MAS Emergency Department/Admissions Office staff/AOD (non-administrative hours) that all articles which are excess to his/her needs, particularly baggage and articles of intrinsic value, should be removed from the medical center by his/her responsible representative.

a. Articles in excess of Veteran needs which cannot be removed from the medical center by a representative of Veteran (items brought by homeless veterans, for example), will be stored in the Veteran Effects Storage Area. These items will not be inventoried; the clothing record card will indicate "miscellaneous clothing." The Veteran will be required to sign the "Veteran Certification of VA Non-Liability" which notes that VA is not responsible in the event of loss or theft.

b. Valuables Inventory Envelope (VAF 10-2637) will be used for storage of valuables that cannot be removed from the medical center (including, unendorsed checks, drafts, jewelry, promissory notes, bonds and other securities). These will be inventoried in the admissions area and placed in the Valuables Inventory Envelope, which will be stored in the safe in the Veteran Effects Storage Area. Item of jewelry will be cataloged according to color of the item. The Veteran or his/her representative will sign the envelope at the time of deposit and withdrawal. The Supervisor, Ward Administration, or the assigned Medical Support Assistant for Mental Health, will be responsible for inventory of valuables for Veterans who are directly admitted to the Mental Health ward.

c. Veteran funds will be turned in to the Agent Cashier during regular duty hours or the Administrative Officer on Duty (AOD) during irregular tours.

d. Veterans are encouraged to wear their own pajamas. Veterans admitted to the hospital, who did not bring pajamas, will be provided a hospital gown. The wearing of personal clothing may be permitted, if documented by the attending physician, for therapeutic reasons on an individual Veteran and in programs such as the Community Living Center (CLC), where delineated by policy for these programs/activities.

9. Each Veteran/resident has the right to keep and spend his/her own money, except for those Veterans/residents who have been judicially declared incompetent or those rated incompetent by VA. These funds will be deposited in restricted accounts on admission.

10. Each Veteran/resident has the right to designate a representative decision-maker in the event he/she is incapable of understanding a proposed treatment or procedure, or is unable to communicate his/her wishes regarding care. The designated decision-maker has the right to approve care, treatments and services relating to the Veteran's care.

11. Each Veteran/resident has the right to have his/her psychosocial, spiritual, cultural, personal values, beliefs and preferences respected in regard to his/her illness and death, as appropriate. Additionally, he/she has the right to optimum comfort and dignity in the event of terminal illness.

12. Each Veteran/resident has the right to social interaction, and regular exercise. He/she will also have the opportunity for religious worship.

13. Each Veteran/resident has the right to information about the health benefits and cost, if any, that they are eligible to receive. The information will be provided in a way the Veteran/resident can understand.

14. Each Veteran's/resident's medical record, and all other information about him/her will be kept confidential unless disclosure is in accordance with applicable law, or he/she consents to its release in writing.

15. Each Veteran/resident has the right to be aware of the medical and/or dental staff who is responsible for coordinating his/her care, treatment and rendered services. In addition, each Veteran/resident has the right to be informed about, consent to, or refuse recommended treatment, care and services and participate in the consideration of ethical issues that arise in the provision of his/her care.

16. Each Veteran/resident will be provided with those hospital, clinic, or CLC rules and guidelines, which apply to his/her responsibility as a Veteran/resident.

17. Each Veteran/resident has the right to initiate a complaint or grievance regarding his/her care. If the Veteran/resident is unable to resolve a problem with the treating physician, he/she should request an opportunity to discuss the matter with service chief responsible for his/her care. If the issue cannot be resolved at this level, it may be brought to the attention of the Chief of Staff for consideration/resolution. The Veteran/resident also has the right to contact the Joint Commission for consideration/resolution of issues.

18. Each Veteran/resident has the right to express a complaint to VA authorities or other federal or state authorities or contact the Office of Patient Advocate and receive prompt attention to matters of concern.

19. Each Veteran/resident has the right to participate in consideration of ethical issues that arise in the provision of his/her care.

20. Each Veteran/resident, or his/her family, has the right to call a meeting of the Ethics Advisory Committee if he/she has any questions about his/her care.

21. Each Veteran/resident has the right to formulate advance directives. VA approves and promotes the right of Veterans to make healthcare decisions and to express their health care wishes through advance directives initiated or provided by the Veteran at admission such as a living will or a durable power of attorney for health care.

22. Each Veteran/resident has the right to have his/her pain assessed and managed appropriately.

23. Each Veteran/resident has the right to be informed of any investigational research or educational activities related to his/her care.

24. Each Veteran/resident has the right to know the name and professional title of the provider in charge of his/her care.

25. In addition to those listed above, each Veteran/resident of the CLC has the following rights:

a. A reasonably private environment which will be respected by staff, visitors, and other Veterans/residents, as well as the right to personalize his/her own share of the environment.

b. Liberal visiting hours which are clearly posted, and visiting privileges that are not limited except on attending physician's instructions for medical reasons.

c. Retention and use of personal clothing.

d. Retention and use of personal possessions as space permits, unless this infringes on rights and/or safety of the other residents.

B. Veterans'/Residents' Responsibilities:

1. To follow all of the medical center's safety rules and posted signs.

2. To be considerate and respectful of all medical center/nursing home personnel and other Veterans/residents.

3. To cooperate with the treatment staff. If he/she has questions or disagrees with his/her treatment plan, he/she is responsible for discussing it with his/her treatment staff.

4. To try to prevent any injury to himself/herself, other Veterans/residents, visitors, and staff members by his/her own actions, and to be responsible for the safekeeping of clothing, money, and personal possessions he/she chooses to keep with him/her while in this facility.

5. To keep his/her scheduled diagnostic and/or treatment appointments.

6. To avoid interfering with the treatment of other Veterans/residents, particularly in emergency situations.

7. To assist by alerting the staff when another Veteran/resident is having difficulty.

8. To encourage his/her visitors to be considerate of other Veterans/residents and medical center personnel, and to observe posted visiting hours.

9. To make sure he/she understands what medication(s) must be taken following discharge from the medical center and whether he/she is scheduled for follow-up outpatient visits.

10. To inform medical center personnel of desired changes in Advance Directives.

11. To refrain from engaging in sexual misconduct. Sexual misconduct for this purpose includes any sexual relations between two or more persons and prostitution. Sexual harassment of others is also prohibited.

12. To assist health care providers with his/her pain management, by notifying them when pain first begins or when the pain is not relieved.

13. To make appropriate arrangements to meet any financial commitment for medical services, if applicable.

C. Veteran/Resident Disciplinary Actions for Failure to Carry Out Responsibility:

1. For patients who demonstrate behaviors that are not consistent with the treatment plan and/or violate the rights and safety of other patients and staff (i.e., abusive, disruptive, non-compliant), a description of the behavior, the assistance provided, and overall effectiveness of the assistance will be documented in the medical record. Problems that are not resolved will be referred administratively through the chain of command beginning with the staff physician to the Office of Patient Advocate for assistance and resolution.

2. Disciplinary/Corrective action (consistent with the nature of the activity or incident) will be applied when the Veteran does not fulfill his/her responsibilities. In determining the action to be taken, the Veteran's mental and physical condition will always be taken into account. No actions that endanger a Veteran's health will be taken. All actions will be taken or authorized by the treating physician and documented in the Medical Record Progress Notes (written or electronic). Penalties are as follows:

a. Minor Penalties: Physicians may impose minor penalties, such as refusal of authorized absences, revocation or restriction of privileges, and denial of attendance at entertainment for infractions not serious in nature.

b. Irregular Discharge Penalty: Veterans whose cooperation and conduct, as those listed below, may be given an irregular discharge by the treating physician.

(1) Election to not accept reasonable treatment including examination and diagnostic work.

(2) Election to not accept transfer to other units of the medical center or to other hospitals for needed specialized treatment.

(3) Failure to return from authorized absence or leave or self-discharge against medical advice. NOTE: Veterans/Residents considered unable to make adequate judgment about their best interest, who are committed, or who have institutional awards will be placed on one of the following types of discharges:

(a) Unauthorized Absence

(b) Non-Bed Care (NBC)

(c) Outpatient Care (OPT)

c. Serious misconduct and/or violations of law such as: Introduction, possession, or use of intoxicating beverages, or illegal use of drugs; introduction or possession of firearms; theft/damage to government or personal property; interference with treatment of other Veterans; use of abusive, profane, or obscene language to personnel or other Veterans/residents; and gambling.

d. Refusal by a competent Veteran to wear an armband may be considered refusal of treatment and may result in disciplinary discharge in accordance with Center Policy Memorandum B-118-10, "Patient Identification."

e. Readmission Following Irregular Discharge: A Veteran/resident who has received an irregular discharge as provided in this center policy will be authorized admission when he/she has satisfied the admitting authority that he/she will conform to expected standards of behavior.

f. Travel Payments: A Veteran/resident who is given an irregular discharge for any of the offenses defined above will not be authorized return transportation to the point from which he/she proceeded on admission except as provided in CFR 17.100(f)(4).

D. Employee Disciplinary/Corrective Actions for Failure to Carryout Responsibility: These matters will be handled in accordance with existing employee policies. Alleged violations of Veteran rights should be handled via the normal supervisory channel or a report may be given to the Center Director.

VI. REFERENCE:

A. Code of Federal Regulation (CFR) 17.66 Notice of Non-Compliance with VA Standards

B. Patient and Nursing Home Residents Rights and Responsibilities, September 2006

C. CFR 17.100(f)(4) Refusal of Treatment by Unnecessarily Breaking Appointments.

D. Center Policy Memorandum B-136-10 Patient Identification

E. Center Policy Memorandum F-125-20 Informed Consent

F. Center Policy Memorandum A-00PS-12 Patient Safety Improvement Program

G. VHA Directive, 2006-055, dated 10/11/2006, VHA Outpatients Scheduling Processes and Procedures, H. VHA Handbook 1004.02, Advance Care Planning and Management of Advance Directives

I. Deputy Under Secretary for Health Operations and Management (10N) subject, Visitation Policy Outreach, dated February 8, 2012

VII. RESCISSION: Center Policy Memorandum B-136-21 dated June 1, 2011

/s/ Shannon C. Novotny for Joe D. Battle Interim Center Director

ATTACHMENTS: None RESPONSIBLE OFFICE: Medical Administration Service (136