PTEC 155 – DEVELOPMENTAL DISABILITIES … the critical elements of clients/patients Bill of Rights 1. Identify from a list the factors, which any client in a hospital can expect

PTEC 155 – DEVELOPMENTAL DISABILITIES

MODULE 40

CLIENT/PATIENT RIGHTS

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TABLE OF CONTENTS

Introduction ................................................................................................................................. 1 Objectives ............................................................................................................................. 2 – 5 Principles .................................................................................................................................... 5 Vocabulary ............................................................................................................................ 7 – 9 Study Guides: 1. Lanterman Petris Short Act .................................................................................... 10 – 12 2. Lanterman Developmental Disability Act ................................................................ 13 – 17 3. Short Doyle Act ...................................................................................................... 18 – 19 4. Client/Patient Advocate .................................................................................................. 20 5. Commitment Procedures................................................................................................ 21 6. Child Abuse Laws .................................................................................................. 22 – 23 7. Criminal Neglect ............................................................................................................. 24 8. Right to Education Act ................................................................................................... 25 9. Informed Consent .................................................................................................. 26 – 27 10. Confidentiality ........................................................................................................ 28 – 29 11. Consumer Protection ..................................................................................................... 30 12. Client/Patient .................................................................................................................. 31 13. Observation and Recording of Violation of Clients’ Patients’ Rights ...................... 32 – 34 14. Admission and Discharge Procedures ........................................................................... 35 15. Periodic and Annual Reviews ........................................................................................ 36 16. Referral Procedures for Problems Concerning Client’s Rights ....................................... 36 17. Respite Care .................................................................................................................. 36 18. In Re: Hop Decision and Its Implications ............................................................... 37 – 38

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Client’s Rights PowerPoint Handout ................................................................................. 39 – 42

Napa Valley College PTEC 155 – Developmental Disabilities

Module 40 – Client/Patient Rights

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INTRODUCTION To be employed in the health care industry is to work with people. As a health care professional, your goal is to tend clients effectively, safely, and in a legally correct manner. There are many laws and regulations from the California State Department of Health, local health agencies, and the individual facility where you will be employed that affect the way you carry out your responsibilities. In order to assist you in the field of employment you have chosen, this body of information has been assembled. It deals with the mentally impaired and developmentally disabled clients from the standpoint of: 1. How they get into the treatment system 2. Their specific rights during that period 3. What constitutes violations of rights, and how they are handled 4. The responsibility of the health care worker to the patient/client 5. The means by which the health care worker can maintain integrity and comply with the legalities of providing care to this group



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OBJECTIVES

THEORY: The successful student will achieve a passing score on a written comprehensive examination based on materials dealing with techniques used to teach and train clients with developmental disabilities in the areas of feeding, positioning, and using orthotic equipment. ASSESSMENT: There will be a written comprehensive objective type test; multiple choice, true/false, and matching questions. MAKE UP TESTS MAY BE AN ESSAY TEST!! INSTRUCTIONAL MEDIA: Study Guides

1. Purposes of assessment 2. Components of assessment 3. Examples of assessment 4. Factors in intervention

TEXT: Beirne-Smith: Chapter 4; pgs 418,429



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OBJECTIVES The successful student will be able to: 1. Give historical perspectives of rights for the D.D. client. a. Lanterman Act - 1969

b. American Disabilities Act – 1970 2. According to textbook identify the rights of the D.D. client and give examples of implementation. 3. Identify the Lanterman Developmental Disabilities Act, as to its intent and implementation.

a. Identify the services covered in the Lanterman Developmental Disability Act b. Identify from a list the purpose and membership of the State Council on

Developmental Disability (1) Identify the “rights” of the developmentally disturbed person

c. Select a definition of respite care 4. Denial of rights under Lanterman Developmental Disability Act a. When may rights be denied

b. What is procedure for denying rights c. What is documentation required d. What constitutes good cause e. Restitution of Rights

(1) When (2) What is involved

5. Identify the function of regional centers as to definition and responsibility

a. Define Regional Center b. Describe services of Regional Centers c. Select the responsibilities the Regional Center has to its clients

6. Judicial Review

a. Define the process and describe what must occur - name the date when this process began in California

b. Name the ruling, which governs this process



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7. Select the means by which advocacy plays a role in client/patient rights

a. Match the term “advocate” with the individual to which it applies under California Law

b. Identify how the advocate is helpful to client/patients, both directly and indirectly

8. Identify the portions of the Child and elder abuse laws, which relate to clients a. Identify from a group of selected situations those which would be considered punishable

(1) Neglect (2) Assault (3) Battery (4) How does this relate to the developmentally disabled

9. Identify Public Law 94-142, “The Education Code”

a. Select from a list the specific segment of the population to which this law applies b. Choose from a list the different programs a community must adopt to be in

compliance with this law 10. Identify the characteristics of “Informed Consent”

a. Identify from a list the critical elements of informed consent b. Differentiate between conditions applicable to a voluntary client and an

involuntarily treated client where consent is concerned c. Identify the specific constraints which apply to psychosurgery as a treatment

modality 11. Identify the importance of confidentiality to clients/patients

a. Select from a group of situations where confidentiality as a protection prevails over the right to know

12. Identify the critical elements of consumer protection in health care

a. Select from a list the items a consumer should be aware of for self-protection 13. Identify the critical elements of clients/patients Bill of Rights

1. Identify from a list the factors, which any client in a hospital can expect as a “right” 14. Identify methods for handling violation of client/patient rights



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a. Who makes up an area board b. Cite responsibilities of an area board c. Select from a group the correct reporting sequence for a program director in a

state facility d. Choose the circumstance, which would involve the Board of Medical Examiners

in a decision 15. Identify conditions, which apply to admissions and discharges under the Lanterman Developmental Disability Act a. Identify the circumstances, which qualify a client for voluntary or other forms of admission b. Select from a list the reporting process in a state facility regarding discharge of a client c. Identify the important factors considered in release decisions d. Identify the difference between provisional and unconditional discharge 16. Identify the role of status reviews a. Select from a group the description of client reviews 17. Identify critical elements of the referral process and clients’ rights a. Select the correct process for resolving accusations of rights violations 18. Respite Care

a. Describe what is meant by the concept of respite care



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PRINCIPLES

1. In this country all human beings have basic rights. 2. Although the status of well being of mind and body may change, one’s basic rights remain unchanged. 3. One individual can easily usurp the rights of another who is mentally impaired. 4. Health care facilities have been known to violate clients’ rights. 5. Laws have been enacted to protect clients’ rights and to discipline those who would violate a right. 6. A person may not be held against his/her will for medical treatment, unless they might be harmful to themselves or others. 7. The health care worker can make “a difference” and improve the patient/client situation.



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VOCABULARY

OBJECTIVE 40-1 Conservatee: The person for whom a conservator has been appointed. Conservator: Is an individual named by the court to represent, safeguard, and make decisions relative to the needs of a person who is at the time incapable of, or unwilling to, make sound decisions on his/her own behalf due to mental impairment. Conservatorship Process: Allows another individual or agency to act on the person’s behalf and to protect his/her interest when he/she is unable to care for self. This named individual or agency is the conservator and is named by the court. Evaluation: Consists of professional analyses of the medical, psychological, social, financial, and legal conditions of an individual where they appear to be creating a problem. Gravely Disabled: A condition in which a person is unable to provide for his/her basic needs for food, shelter, and clothing and which results from a mental disorder or impairment from alcoholism. Habeas Corpus: The object of habeas corpus is to allow a person deprived of his/her liberty the opportunity to affect release from an institution by means of a court hearing where the individuals seeking to detain him/her must defend their actions. Impaired: Damaged, deteriorated, less than. Judicial Review: A court hearing where a qualified and unbiased representative will hear arguments from the persons charged with detaining the client involuntarily and whose responsibility it is to determine if the persons acted in the best interest of the client. It always involves a patient’s/client’s request for release. Lobotomy: A controversial and little used procedure whereby certain areas of the brain are destroyed surgically in order to alter behavior. Shock Therapy: A mild electric current passed to the brain, which results in immediate unconsciousness and a grand mal seizure. It probably alters the physiology of the brain and seems to improve depression and the manic phase of schizophrenia.



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VOCABULARY OBJECTIVE 40-2 Behavior Modification: Changing behavior from less desirable to more acceptable by reinforcing the positive behavioral changes. Developmental Disability: A disability originating before an individual reaches age 18 years, continues, and/or can be expected to continue indefinitely, and which constitutes a substantial handicap for said individual. The term includes mental retardation, cerebral palsy, epilepsy, and autism. Psychosurgery: Surgery on brain tissue in order to change behavior for the better. The hope is to destroy minute bits of tissue where undesirable behavior originates. Regional Center: A community agency where developmentally disabled individuals and their families can seek services throughout their lifetime. OBJECTIVE 40-5 Crisis Intervention: To come between an individual and a situation foreseen as threatening in an effort to assist the person with problem solving. OBJECTIVE 40-6 Client/Patient Advocate: One who represents, speaks for, and/or attends to the interests of another who may not be able to speak for himself/herself or who does not have knowledge about his/her rights in the situation. OBJECTIVE 40-7 Commitment: Refers to the right of a parent, probation officer, or others to request the court to place an individual into a state facility for care when they have evidence that the individual is a danger to self or others. OBJECTIVE 40-8 Abandonment: Similar to neglect. Usually applied to parents who fail to provide food, shelter, and clothing to their children. Neglect: Lack of due caution and wanton and reckless disregard for the safety of others.



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VOCABULARY

OBJECTIVE 40-10 Informed Consent: To give consent for a procedure to be performed on oneself or another individual after having heard the name, nature, risks, alternatives, and projected measure of success. OBJECTIVE 40-14 Incident Report: A description in writing of an unexpected or unusual happening involving a client/patient in a treatment facility. OBJECTIVE 40-16 Interdisciplinary Team: A group of professionals and paraprofessionals who jointly plan for and treat patients/clients.



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STUDY GUIDE 1 LANTERMAN-PETRIS-SHORT ACT

This California State law applies to the mentally disordered person and to the persons impaired by chronic alcoholism. The goals of the Lanterman-Petris-Short Act are: 1. To end inappropriate, indefinite, and involuntary commitment of mentally disordered and alcoholically impaired persons 2. To provide prompt evaluation and treatment 3. To guarantee protection to the public 4. To safeguard an individual’s rights 5. To provide individualized treatment, supervision, and appointment of a conservator if gravely disabled and where necessary 6. To be cost effective in providing such care by preventing duplication of services and using existing facilities to the fullest Major provisions under Lanterman-Petris-Short Act are: 1. Involuntary Detention of 72 hours for reasons of evaluation and treatment Persons gravely disabled or deemed a danger to themselves or others may be detained in a facility – state approved to treat psychiatric diagnosis for a period of 72 hours. This detention can be recommended by a peace officer, physician, or other professional designated by the country to have such rights. Documentation of the circumstances, which led to the detention, is mandatory. Evaluation of the client on 72-hour detention must begin as early as possible. (The 72 hours is exclusive of weekends and holidays for the mentally impaired but includes them from the alcoholic detention). A person can be released earlier than 72 hours if, in the opinion of the professional person in charge of the facility, the client is no longer a danger to himself or others and can receive appropriate treatment as an outpatient on a voluntary basis. At the end of 72 hours, a client being held involuntary must either be discharged, agree to stay on voluntarily, or be certified to remain for further treatment. 2. Certification for treatment If at the end of 72 hours the client is still considered a danger to himself or others by the professional (physician in charge of the case) evaluators of the case, the responsible physician and one other professional (can be doctor, nurse, social worker) may together certify him/her to remain for treatment up to an additional 14 days. If at the completion of the 14 days of treatment, the client is still involuntarily held and who is still suicidal, recertification



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for another 14 days – one time only – is often recommended. Where a client is a real danger to others at the end of 14 days of recertification, recommendation may be made to the court for an additional certified period of 90 days (rarely used). If the client is gravely disabled and continues to require involuntary detention at the end of the first 14-day certification, he/she must be recommended for conservatorship, which requires a court hearing. The mentally impaired and chronic alcoholic cannot be judicially committed. 3. Legal and Civil Rights of the Involuntarily Detained The following list of “rights” must be prominently displayed in treatment facilities and be available in Spanish as well as English. The following rights are guaranteed:

a. Wear his/her own clothes b. Keep and use personal possessions and toilet articles c. Keep and be allowed to spend a reasonable sum of money for personal effects d. Have access to an individual storage space for personal effects e. See visitors daily f. Have ready access to telephones, both to make and receive calls within reason g. Receive unopened correspondence and have writing materials available for client’s

use h. Refuse shock treatment i. Refuse lobotomy

4. Denial of Rights A person’s rights may be denied “for good cause” only by the professional person in charge of the facility, or his designee. The rights to refuse electric shock therapy and lobotomy, however, are not deniable by anyone in any facility. Such denial of involuntarily detained person’s rights requires recording in the treatment notes. Such information must be made available on request of the person, his/he attorney, hi/her conservator or guardian, or members of State Department of Mental Health, the State Government, and/or a member of County Board of Supervisors. 5. Reports When a client is certified for treatment and involuntarily held, he/she must receive a copy of the certification statement and be advised of his/her rights to judicial review by habeas corpus. Said client also must receive an explanation of what judicial review means, and the client’s right to legal counsel must be explained. A copy of the certification must be filed with the State’s Superior Court, client’s/patient’s attorney, the district attorney, the public defender (if any), the facility providing the



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treatment, and to the State Department of Mental Health. 6. Confidentiality All records of persons whose care is covered by provisions of Lanterman-Petris-Short Act (such as all health care and/or other treatment facilities) are confidential. Disclosure is allowed only:

a. Between attending qualified professionals b. In the course of conservatorship proceedings c. To the extent necessary to receive insurance or other medical aid d. To courts, when required e. To an attorney for the client with the client’s signature for such release This has much significance for the licensed psychiatric technician working in this field. The dilemma of being asked for confidential information on the phone is a serious one. If the licensed psychiatric technician is not convinced that the caller is a physician or other persons entitled to this information, he/she cannot respond. One cannot even identify if the client is, in fact, on the unit, as this would violate the client’s right to confidentiality.

7. Conservatorship Any individual whose mental impairment requires detention involuntarily beyond a 14-day certification must be recommended for conservatorship under Lanterman-Petris-Short Act. This requires a court hearing. If a conservator is named, the period of authority lasts one year, and renewal, if needed, may be applied for. Such conservators under Lanterman- Petris-Short Act may place their conservatees in treatment facilities (under probate conservatorship, this authority does not exist). The conservator has the right to sign consent forms related to mental health services in place of the conservatee. A conservatorship limits the client’s right to drive a motor vehicle, won and bear firearms, and enter into contracts. In practice, the public guardian is usually designated as conservator, but a relative or other can be named. 8. Lanterman-Petris-Short Act and Licensed Health Care Professionals The law states that a registered nurse or social worker may co-sign with the physician on detention records of clients who fall under the Lanterman-Petris-Short Act. For other professionals, including the licensed psychiatric technician, the facilities’ policies and procedures would guide such an employee to learn if they can or should ever be so involved. Every employee needs to become acquainted with the policy as soon as possible.



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STUDY GUIDE 2 LANTERMAN DEVELOPMENTAL DISABILITY ACT

STATE OF CALIFORNIA POLICY ON DEVELOPMENTAL DISABILITY The state accepts responsibility for its developmentally disabled citizens and recognizes the impact on communities of their social, economic, medical, and legal problems. The State understands the complexity of providing coordinated services, which allow no gaps, and is prepared to provide the same. The State plan is to meet the needs of each person with developmental disabilities (D.D.) regardless of age, degree of handicap throughout the person’s life stages, and without dislocation of persons from their home communities. The State has a plan for monitoring the results of its program for effectiveness. STATE COUNCIL ON DEVELOPMENTAL DISABILITY The California State legislature saw a need to coordinate the services, expenditures, and funding for this specialized group in order to assure the rights of the individuals, and so a State Council on Developmental Disability was formed. This council has authority to act independently of any single state service agency. The State Council coordinates the services and funding for D.D. persons In 2003, the State Council and Area Board were combined by Governor Arnold to form a single state-appointed agency. ‘RIGHTS’ OF THE DEVELOPMENTALLY DISABLED PERSON Persons with D.D. have the same legal rights guaranteed to other individuals by the Constitution. Any program or activity, which receives public funds, may not discriminate against nor exclude from participation in such activity any individual on the basis of a developmental disability. Legislation in the state of California intends to assure the following rights to the developmentally disabled persons: 1. A right to treatment and habilitation services under the least restrictive circumstances possible. 2. A right to dignity, privacy, humane care. 3. A right to participate in an appropriate program of publicly supported education, regardless of the degree of handicap. 4. A right to prompt medical care. 5. A right to religious freedom and practice.



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6. A right to social interaction and participation in community activities. 7. A right to physical exercise and recreation. 8. A right to be free from harm, unnecessary physical restraint, isolation, excessive medication, abuse and neglect. 9. A right to be free of hazardous procedures. In addition to the above-legislated rights, the developmentally disabled person who is admitted or committed to a treatment facility has other rights related to said facility. These rights are the same as the legal and civil rights of the involuntarily detained. 10. To wear his/her own clothes, to keep and use personal items such as toilet articles, and to keep and be allowed to spend reasonable sums of his/her own money for small purchases. 11. To have a private storage space. 12. To see visitors daily. 13. To have reasonable access to telephones, including privacy with use. 14. To receive unopened correspondence and have access to letter writing materials. 15. To refuse shock therapy. 16. To refuse behavior modification therapy, which causes pain or trauma. 17. To refuse psychosurgery where its purpose is to modify thoughts, feelings, actions, behaviors, and where no diagnosis of physical disease of the brain has made to account for said thoughts, behaviors, etc. DENIAL OF THE DEVELOPMENTALLY DISABLED CLIENTS’ RIGHTS The rights (or some of them) of a person may be denied for “good cause” during a period of stay in a treatment facility. To ensure that rights are denied ONLY for good cause, the Director of Developmental Services shall adopt regulations specifying conditions where such denial would be appropriate. Therefore, if and when a “right” is denied: 1. It must qualify under the specification for same. 2. It must be entered into the client’s record. 3. It must be included in a quarterly report to the Director of Developmental Services.



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4. On request, such denial information must be made available to the client, his/her parents, guardian, attorney and members of State Developmental Services. The only person who has the authority to deny a right is the Administrator of a care facility; he/she has the obligation to confer with the client’s physician and/or social worker first to be assured that “good cause” exists. “Good Cause” is said to exist when: 1. Exercise of the specific right would cause injury or would seriously infringe on the rights of others. 2. The facility would suffer serious damage. 3. There is no less restrictive way of protecting the individual, other clients, and facility. 4. The reason used to justify the denial of a right is related to the specific right denied. (Rights shall not be withheld as punitive measures). 5. Treatment modalities do not include denial of any specific right. DOCUMENTATION OF DENIAL OF RIGHTS 1. Note in client treatment record immediately. 2. Include – date and time of denials, specific right denied, good cause for denial, projected date for review (at thirty (30) days or sooner). 3. Signed by either the administrator of the facility or administrator’s designed. 4. The patient/client must be told of the contents of such notation. 5. Each denial must be documented regardless of its gravity or the frequency or occurrence. RESTORATION OF RIGHTS When “good cause” for denial no longer exists, a right shall be restored. Appropriate documentation of restored right in the treatment record is essential. REGIONAL CENTERS FOR PERSONS WITH DEVELOPMENTAL DISABILITY A regional center for D.D. is a fixed point of contact in the community where persons with D.D. and their families can seek services throughout their lifetime. Scope of Responsibility:



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1. In 1977, the Director of Developmental Services for the State Delineated by diagnostic

category and degree of handicap, those persons eligible to be served by regional centers.

2. Regional centers are required to conduct case-finding activities in their service areas by distributing the availability of their services in both English and other predominant languages in the area.

3. If an individual requests assistance from a regional center, the individual is to receive the

initial interview – with gathering of information – within 15 days of first contact.

4. When the initial interview points to a need for full assessment – including historical data, diagnostic test, evaluation and summarization – such workup must be completed within 60 days.

5. The regional center may provide preventive services to any potential high-risk client.

6. When a person seeks service from the regional center but is found to be ineligible, the

reasons for denial for service must be forwarded in writing to the individual. At times, referral to another service is appropriate and can be done

a. Will cooperate with other area departments, which are responsible for disseminating

information about services for the D.D., as well as providing materials and educational programs to community groups.

b. Will make all referrals of clients to developmental centers for the developmentally

disabled (except those committed by the course and these consist of persons proven to be a danger to themselves or others).

c. Will accept the referral from a developmental center when a developmentally disabled

person is being discharged from the state hospital. d. May give consent for medical, dental, or surgical treatment for a client when the

parent or guardian does not respond within a reasonable time to such demand for consent.

SUPPORT SERVICES FOR PERSONS LIVING AT HOME The State places a high priority on providing assistance so that persons with D.D. can continue to live in their normal home environment. To this end, the State provides to the extent it can, the following services: 1. Specialized medical and dental care 2. Training for parents 3. Infant stimulation programs 4. Respite care for parents 5. Homemaker service



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6. Camping 7. Day care 8. Babysitting 9. Counseling 10. Behavior modification programs 11. Special equipment, i.e., wheelchairs, special beds 12. An advocacy group to assist in securing monetary benefits to which the D.D. clients are

entitled JUDICIAL REVIEW Every adult who has been admitted or committed to a State Hospital as a developmentally disabled person has a right to a hearing by writ of habeas corpus for his/her release. When a client requesting release approaches a staff member of a state facility or a regional center or a mental health treatment center, that employee must promptly do the following: 1. Provide the form and assist the client in completing the form (release request).

2. Have the client sign his/her signature or make his/her mark.

3. Forward to the administrative head.

4. Send copies to the client’s parents/guardian/conservator and to the Superior Court of that

county. The court will hear evidence of the case and decide in the client’s best interest about release, community placement, community referral, or continuation of stay in the current treatment center.



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STUDY GUIDE 3 SHORT-DOYLE ACT

The intent of the Short-Doyle Act was to organize and finance community mental health services for the mentally disordered in every county through locally controlled and administered mental health programs. It was also intended to use existing resources at both state and local levels more effectively, to integrate and unify state-operated and community operated mental health programs, to provide participation by local governments in determining the needs for and allocation of funds for mental health, to make the ratio of local and state funds uniform. Also, it was intended to provide reimbursement to local government for certain services to the mentally retarded and persons afflicted with alcoholism. GUIDING PRINCIPLES UNDER SHORT-DOYLE ACT 1. The plan must make optimum use of local, public, and private organizations and professional

personnel in order to best utilize available funds.

2. To the extent possible, the plan shall provide alternatives to inpatient treatment.

3. Counties that decrease expenses for inpatient treatment in any year shall receive a similar amount for new and expanded services requested.

4. Where there are plans to close a state hospital within a county, the plan shall include means

of absorbing as many staff employees of that hospital as feasible by transferring into the local mental health programs. If necessary, occupational positions can be redefined, and licensed psychiatric technicians will be recognized for the treatment of all the disordered groups falling under this Act.

5. Basic services under the plan include:

a. A system to ensure quality of care and appropriateness for clients placed in out-of-home care facilities.

b. Maintenance of a resource registry to facilitate the placement process. c. Consultation, training, and such other special services as needed to maintain the quality of care in pre-care and aftercare facilities for clients. 6. A system of follow-up care to maximize the client’s adjustment to the community by receiving the needed referral and support.



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FINANCIAL ALLOCATIONS Services for the mentally disordered, fall under one state appropriation which is made to the State Department of Mental Health. After review and acceptance of the county Short-Doyle plans, the director of mental hygiene determines the amount of state funds available for each county. When allocating funds for new programs, the director uses the following order of priority: 1. Crisis intervention 2. Outpatient and day treatment 3. Partial hospitalization 4. Residential treatment 5. Inpatient treatment The ratio of state funds to county funds is 90 – 10. The director may delegate to counties the responsibility of determining each client’s ability to pay and collecting same.



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STUDY GUIDE 4 CLIENT/PATIENT ADVOCATE

Under the “Welfare and Institutions Code” of the state of California, persons who are developmentally disabled and those mentally disabled are to be assigned a client’s advocate. This individual handles complaints of abuse, unreasonable denial, or punitive withholding of a right. If the advocate is a staff employee, he/she must not be involved in direct supervision of client care in that facility. The client advocate will conduct an annual review of the client’s rights program in each local mental health program. SPECIFIC DUTIES OF THE ADVOCATE: 1. Ensure that patient/client rights are posted in all facilities.

2. Ensure that all incoming clients are notified of their rights.

3. Assist with training staff about “rights”.

4. Investigate complaints.

5. Act as advocate for a client who is unable to register a complaint due to his/her mental or

physical state.

6. Act as liaison to the patient/client rights specialist, a member of the Department of Health.



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STUDY GUIDE 5 COMMITMENT PROCEDURES

Since 1971, persons with mental disorders, chronic alcoholism, and those who are mentally retarded, cannot be committed to a state facility for care unless he/she is a danger to self or others. Such a petition for commitment may be filed with the parent or guardian, a district attorney or probation officer, the youth authority or the director of corrections. The petition must state reasons for supporting the commitment. The court will set a hearing date. The individual must be a resident of the state in which commitment is being advised. (However, one state will care take an individual from another state until such transfer can be made). Decision is made with the help of expert and other witnesses. A commitment order is valid for only one year and must be re-evaluated annually. A person who is committed does not have a right to jury trial under habeas corpus.



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STUDY GUIDE 6 CHILD ABUSE LAWS

In 1956, California made its first law governing child abuse. In 1974, the Federal government laid down criteria on methods of treating the abused child along with funds for those states meeting the criteria. Professionals (particularly in health fields, but also teachers) are mandated by law to report known or suspected cases of child abuse. An “abused child” is anyone under age 18 who lacks proper effective parental care and control; who is not provided with a suitable home and food and other necessities of life; whose home is unfit by reason of neglect, cruelty, depravity, or physical abuse by one or both parents, guardian or other in whose care the child is. The Orange County, the responsibility for the care of these children has been transferred from the Probation Department to the Department of Social Services. (Check your local area for information about the department responsible). To report a case of abuse or suspected abuse: 1. Call “The Child Protective Services”.

2. This is a 24-hour registry.

3. The registry is under the Department of Social Services, and one of their staff will make the

contact to assess the report.

4. If they believe there report valid, they make the police report and the case follows channels for resolution (including help for both the child and parent).

5. If the report is found to be invalid, there is no police report and the case is dropped.

6. Even if found later to be invalid, no civil or criminal liability is attached to a report, if made in

good faith.

7. A person who has knowledge of abuse and does not report if can, after the fact, be sued for damages on behalf of the child.

8. It is a misdemeanor to not report a known child abuse.



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Definitions of assault and battery are: ASSAULT: Is an attempt to strike, or a threat, which evokes fear in the victim. BATTERY: Is a consummated assault. A victim injured by willful physical force or a blow by an object has been abused by “battery” Under the Lanterman law pertaining to developmentally disabled persons, a legislated “right” is to be free from unnecessary physical restraint, abuse, and neglect. Relative to this law, state facilities have written policies with which each employee must be familiar and which outline a reporting system to investigate and punish any individual accused of violating the client’s right to humane treatment.

STUDY GUIDE 7

CRIMINAL NEGLECT

The courts specify certain elements, which must be present before an individual, or group could be judged guilty of criminal neglect. These elements are: 1. Lack of due caution 2. Some measure of wantonness of flagrant and reckless disregard for the safety of others



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STUDY GUIDE 8 RIGHT TO EDUCATION

A Federal law enacted in 1975 gave federal money to states and local communities to expand educational opportunities to developmentally disabled clients. In essence, the law mandates that appropriate free, public education be made available to handicapped children up to age 18 or 21 depending on the laws in that state relative to normal children. Each child must have an individualized education program designed by a qualified representative of the local educational agency. This plan will include a statement about the child’s present level of performance, the annual goals for the child, specific educational services to be provided, the extent to which the child will be able to participate in regular programming, projected date of the commencement of instruction, and methods and criteria for evaluating achievement (on an annual basis). The date of September 1, 1978, was legislated as a deadline for states to have an approved plan of action ready with which to implement this law on education for the handicapped – otherwise known as Public Law 94 – 142. The states were also charged with providing the educational programs to the handicapped in schools frequented by the non-handicapped so as not to remove them from normal school environments. Where the severity of the handicap made this impossible, other arrangements are acceptable. While testing and evaluating a child for level of performance, racial and cultural discriminations are forbidden. Also, no one single criterion shall determine an appropriate educational program (such as ONLY an IQ test). Emphasis should be placed, too, on free educational opportunities like non-handicapped children’s free educational opportunities. It also emphasized “special instruction” designed to meet their unique needs. This term means specially designed instruction to meet the needs of an individual, including classroom, physical education, home instruction, and where needed, instruction in hospitals and institutions.



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STUDY GUIDE 9 INFORMED CONSENT

A standard written consent form, which is applied to other clients before treatment procedures must also be used for those, affected by mental disorder, alcoholism, or mental retardation. The following information must be included: 1. The reason for treatment, which translates to the nature of the client’s illness or defect. 2. A description of the procedure intended and its duration. 3. The probable degree of improvement expected, with and without the treatment. 4. The nature of possible side effects, risks, as presently known to medical practitioners. 5. Reasonable alternatives. 6. That the client has the right to accept or refuse the treatment and can change his/her

mind up to the time of commencement of treatment. Other important facts about consents are: 1. The signed consent form, along with a physician’s statement that information relative to

the procedure has been given the client, becomes part of the permanent record.

2. The physician or other persons may not use coercion, reward, or threat to gain consent for treatment from a client.

3. When psychosurgery is contemplated, a client may elect to have a responsible relative

or guardian hear the physician’s argument in favor of the procedure, however, were the client chooses confidentiality, such a move is dispensable and the client alone can make the decision.



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4. Three physicians must examine a client before psychosurgery and declare the client

capable of giving an informed consent.

5. Psychosurgery cannot be performed before 72 hours following the client’s written consent, and it can never be performed on a minor.

6. To administer convulsive therapy to a client who is being involuntarily held, two

physicians, besides the attending physician, must have examined the client and unanimously agreed that all other modalities of treatment have been explored, and that this one offers the best chance for results.

7. The treatment plan shall not exceed 30 days and can be revoked by the client at any

time.

8. If the attending physician or the client’s attorney feels that the client is incapable of giving informed consent for shock therapy, a petition can be filed in court to determine same. If the court decides that the client is incapable of giving informed consent, then a responsible relative, guardian, or conservator can give such consent.

9. If the client, voluntarily admitted, is in need of shock therapy according to

documentation in the record by the attending physician, the client’s consent is considered valid after one physician (other than the attending) has given verification that the client is capable.



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STUDY GUIDE 10 CONFIDENTIALITY

The Welfare and Institutions Code of the State of California is specific regarding confidentiality for persons affected with developmental disability, chronic alcoholism, and mental impairment. Whether the person is voluntarily or involuntarily treated does not change the confidentiality with which records and other information must be handled. Some basic regulations are as follows: 1. Information and records may be transferred between qualified professionals providing

services and in the course of conservatorship proceedings. However, where information is going from a professional employed by the caring facility to a professional not employed by the facility who does not have medical responsibility for the client, the consent of the client or guardian must be obtained.

2. If the client elects to have information given to designated persons and his/her

psychologist or psychiatrist agrees, this can be carried out.

3. To the extent information needs to be revealed in order to make a claim on medical or other insurance on behalf of the client, such revelation can be made.

4. When the client is a minor, ward, or conservatee, the responsible party may authorize –

in writing – the designated persons to receive needed information.

5. Courts have access to necessary information.

6. Law enforcement agencies may have information necessary to protect public-elected officials and their families.

7. An attorney representing the client’s interests may have access to records upon the

written consent of the client. If the client is unable to make such consent, the staff (of facility) may release such information as necessary.



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8. Should an individual, once treated by a facility, become involved in a criminal charge, the administrator of the facility may release information as requested by a probation officer, when the information seems relevant.

9. In all of the preceding conditions, confidential information provided by a client’s family to an attending professional may be held in confidence if the person so chooses.

10. A family member has the right to know that the relative is being treated at a given

facility if the family member so inquires, and if the professional person in charge of the facility determines such information to be in the best interest of the client.

11. Should a client elope from a facility where his/her presence was the purpose of

treatment, such disappearance should be reported to relatives and law enforcement agencies for the protection of the client and others.

12. If a client while confined in a treatment facility commits a crime or is the victim of a

crime, the physician in charge of the facility should release information directly related to such criminal circumstances to the law enforcement agency.

13. Where consent forms are necessary for release of information, such forms shall include

the type of information being released, the name of individual or agency to whom the information is going, and the name of the responsible person authorizing release of information. A copy is then given to the client, as well as an entry of the action into the client record.

14. On the request of a one-time client, records of treatment may be forwarded to a

physician representing a prospective employer, but only if considered to be in the best interest of the individual according to that person’s attending physician.

15. Should a client die in a state mental hospital from whatever causes, the physician in

charge of the client must release all factual clinical treatment information to the coroner. Such information is confidential to the coroner and is sealed when he has completed his findings.



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STUDY GUIDE 11 CONSUMER PROTECTION

Under California’s Administrative Code, which applies to health treatment facilities, there is a portion, which outlines safeguards for the consumer. To this end, all health facilities must post information, which would assist the public to make personal choices for use of such facilities. Displayed prominently should be the following: 1. A list of all services provided.

2. Information regarding admission and discharge policies.

3. A report of the most recent licensing visit.

4. A list of other treatment facilities owned by the same person(s) or corporation.

5. Notation of any suspension action against the facility by a licensing body during the

most recent licensed period.



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STUDY GUIDE 12 CLIENT’S/PATIENTS’ RIGHTS

The California Administrative Code states that an individual, though hospitalized, has basic rights, which cannot be compromised. Each health-related facility providing care must display a copy of the clients’ Bill of Rights or in some other way make the client acquainted with their philosophy about client rights. The following is a list of clients’ rights: 1. Clients have the right to considerate and respectful care.

2. Clients have the right to know by name the physician responsible for coordinating their care.

The client also has the right to know the name of the person responsible for the procedures and/or treatments.

3. Clients have the right to refuse treatment to the extent permitted by law.

4. Clients have the right to every consideration of their privacy concerning their own medical care

program. Case discussion, examination, and treatment are confidential and should be conducted discreetly. Those not directly involved in the client’s care should have permission of the client to be present.

5. Clients have the right to expect that all communications and records pertaining to their care

should be treated as confidential.

6. Clients have the right to expect that within its capacity a hospital should make reasonable response to the request of a client for services.

7. Clients have the right to obtain information as to any relationship of their hospital to other health

care and education institutions, in so far as their care is concerned.

8. Clients have the right to be advised if the hospital proposes to engage in or perform human experimentation affecting their care or treatment. The client has the right to refuse to participate in such research projects.

9. Clients have the right to examine and receive an explanation of their bill, regardless of source of

payment.



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10. Clients have the right to know what hospital rules and regulations apply to their conduct as a client.



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STUDY GUIDE 13 OBSERVATION AND RECORDING OF VIOLATION OF CLIENTS’/PATIENTS RIGHTS

To safeguard the civil, legal and service rights of persons with developmental disability, the State of California has set up area boards whose responsibility covers a given geographical segment. Before 2003, the area boards were made up of members from the general public – 50%, and persons with D.D., or their relatives or guardians – 50%. As of 2003, the governor has combined the area board and the state council on disabilities into 16 state-appointed political positions no longer made up of members of the general public. These area boards have multifold responsibilities, among which is the protection of client rights. They have authority to pursue legal and administrative routes to secure protection for rights of clients. They must remain informed about quality of service, fire and safety standards within a facility, and where possible violation exists, reports are made to state and local licensing agencies. Should an area board receive evidence of criminal misconduct by an individual or agency, the board must at once inform the appropriate law enforcement agency, the board must at once inform the appropriate law enforcement agency. Regional centers have the option of reporting any agency found to be not in compliance with local, state or federal laws on client rights to the area board. In addition, each facility, which treats and cares for persons with D.D., has a written policy dealing with violation of clients’ rights. In general, this policy states that each employee bears responsibility for the safety and well being of clients: that they must be alert to any incidence of mistreatment, neglect, or abuse. An employee may never strike or inflict cruelty by physical means on a client, nor by psychological means. Where strength is required to gain cooperation of clients, sufficient assistance from other employees is recommended so as to prevent injury to clients. Any employee violating these regulations will be subject to discipline, and failure to report mistreatment observed is equally subject to disciplinary action. Any employee channels for observed mistreatment are as follows: 1. Report to program director. 2. Ask for client examination by a physician. 3. Complete a “Special Incident Report”. 4. The program director must immediately report the incident to the executive director, the facility

investigator, the clients’ rights advocate, and the facility peace officer. Under Lanterman-Petris-Short, the persons in treatment for chronic alcoholism or mental impairment have safeguards for their rights: however, they deal more concertedly with violation of the client in the methods of treatment. For example, when there is any suspected or alleged violation of laws regarding treatment and consent (as described in this module under “Informed Consent”), the occurrence must be reported to the director of mental health at the local agency. The director, in turn, sends a report of



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same to the Board of Medical Examiners and they, in turn investigate further, and if warranted, will subject the physician (s) to penalties.



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STUDY GUIDE 13 OBSERVATION AND RECORDING OF VIOLATION OF CLIENTS’/PATIENTS’ RIGHTS

Violation of Client’s Rights

Incident Report (Sample Form)

CLIENT’S NAME: LEGAL STATUS: CLIENT’S ADMISSION NUMBER: DATE OF ADMISSION: UNIT: PROGRAM: DATE CONTACTED: REPORTING PARTY: DISCIPLINE: COMPLAINT AND/OR VIOLATION OF RIGHTS (Include date and time):

INVESTIGATION REPORT (Date):

SOLUTION/SUMMARY:



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STUDY GUIDE 14 ADMISSION AND DISCHARGE PROCEDURES

The mentally impaired and chronic alcoholic can be admitted voluntarily, involuntarily, and by court order (specific conditions described under Lanterman-Petris-Short). Like any other client, if voluntarily admitted, the client may leave the treating facility. Where involuntary or court-ordered admissions are involved, the client has been certified as possibly harmful to self or others and can be held against his will for limited periods (also described under Lanterman-Petris-Short). The developmentally disabled client can only be placed for care outside of the parental home by referral through a regional center. Every effort is made to provide care in the community, but when it is evident that no suitable community-facility exists, admission to a state facility is arranged---again, through the regional center. There may be a waiting period to a program which best fits the clients’ needs for maximal rehabilitation. Any client declared D.D. and residing in a state facility, has the right to request discharge regardless of whether his/her presence there was voluntary or by involuntary commitment. State regulations change from time to time relative to exact procedure to follow, but some basic policies prevail. They are: 1. If a client expresses a desire to leave, the staff member must take the request seriously and

notify a member of the program management or the client’s advocate, as well as making a notation on the clients’ record.

2. A conference will be held within 24 hours to determine the validity of the request. In making this

determination, the client’s ability to understand, communicate, and function are considered.

3. Where a decision is made that no serious personal harm to the client would result, release may be advised and the discharge must be completed in five (5) days.

4. If a decision is made that serious personal harm could result to the client, the regional center is

notified to determine if five (5) days whether community placement or judicial commitment is more appropriate.

5. There are circumstances where a client in a state facility is transferred to community housing as

a more appropriate living arrangement. Under that condition, the client may return to the state facility anytime with a six (6) month period if the arrangement is unsatisfactory; but when the client requests release and is discharged, he/she is not eligible to return. Federal regional centers are always involved with discharges.



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STUDY GUIDE 15

PERIODIC AND ANNUAL REVIEWS OF CLIENT/PATIENT STATUS

Every client with developmental disability has a baseline study made by an interdisciplinary team at admission, which measures the physical, behavioral, and emotional status of the person. A program is set up by this interdisciplinary team, which is designed to move the client toward maximum potential in these same areas. At least annually, the program is reviewed by the interdisciplinary team along with the client and his/her parent or guardian (if they choose to attend). The intent of this meeting is to evaluate progress and make changes in the program where it seems fitting.

STUDY GUIDE 16

REFERRAL PROCEDURES FOR PROBLEMS CONCERNING CLIENTS/PATIENT RIGHTS

Where it appears to a staff member that a client’s right(s) are being violated, the staff member should alert the program manager and also the client/patient advocate. Within two (2) working days, the advocate is to take action to review and resolve it. If the client/patient is dissatisfied with the action later, the matter must be referred to the local mental health director (for mental disabilities) and to the director of the regional center (for developmental disabilities). These referrals must be made within five (5) working days. Should the complaint not be resolved satisfactorily by that body within ten (10) working days, it must be referred to a patients’/clients’ rights specialist at the department of health who must make the decisions. An appeal can be made from the decision of the patients’/clients’ rights specialist to the Director of the State Department of Health.

STUDY GUIDE 17

RESPITE CARE

The State Plan (California) for the care of children with developmental disabilities places high priority towards maintaining the child within the family home where possible. To this end, assistance is provided by the State to families for “respite care” in order to help them with the long-term care such children require. Simplified, this means that the State provides funds to pay individuals who can replace a parent for short periods in caring for the developmentally disabled person.



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Slide 1

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Lanterman Act passed in 1976 State Council on Developmental

Disability formed to enact law– can act independently of any state agency– advocates for client’s rights– 2003 area board and state council combine

positions become appointed by governor– Area board oversees quality of service,

safety standards, rights issues Basic rights are constant

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Slide 3

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Client’s Rights continued

read study guide 13,16– Violation of rights: must notify program director

and advocate: must act within 2 working days– Abuse: doctor, program director, advocate,

investigator, police officer all must be notified report to program director any violations client’s program reviewed annually at IPP

and upon admission (30 day review)

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Slide 5 Denial of Rights

Good Cause– cause injury– physical damage– less restrictive way must be attempted– reason for denial must be related to

specific right; staff convenience?– treatment plan should not include rights

denial

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Documentation

Must be reviewed every 30 days must be signed by client’s rights

advocate or unit physician

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Slide 7 Regional Centers

Formed in 1977 makes placement referrals may act as a conservator

– gives consent for medical, dental, and surgical treatment if family doesn’t respond

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Advocate All clients MI and DD have a client’s

rights’ advocate rights are posted incoming clients notified of rights train staff about rights investigate complaints advocate for clients unable to register

complaints Client’s rights specialist: last referral

point

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Slide 9 Right to education

must be personalized with evaluation tool

include expected date of graduation, annual goals

can’t only use IQ test to place client in program– mainstreaming @ Altimira

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Slide 11 __________________________________

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Slide 13 Abuse and Neglect

Assault: attempt to strike or threat which evokes fear in victim

Battery: physical assault Abuse: can be physical, verbal,

psychological, or sexual Neglect: lack of care; not giving

treatments, meds, meals Report incidents of abuse immediately

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_ Slide 14 Informed Consent

Must include the following: nature of illness description of procedure improvement expected risks, alternatives client’s right to refuse treatment regional center can give informed

consent if client is unable violations reported to Board of Medical

Examiners

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Slide 15 Confidentiality

Don’t use last names must check with client or social worker

for photo clearance Client request for placement must be

addressed within 24 hours Decision must be made within 5 days

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Documents

PTEC 155 – DEVELOPMENTAL DISABILITIES … the critical elements of clients/patients Bill of Rights 1. Identify from a list the factors, which any client in a hospital can expect