Sec. 17.33 Patients' Rights.

[allan]

[Code of Federal Regulations]

[Title 38, Volume 1]

[Revised as of January 1, 2007]

From the U.S. Government Printing Office via GPO Access

[CITE: 38CFR17.33]

[Page 632-635]

TITLE 38--PENSIONS, BONUSES, AND VETERANS' RELIEF

CHAPTER I--DEPARTMENT OF VETERANS AFFAIRS

PART 17_MEDICAL--Table of Contents

Sec. 17.33 Patients' rights.

(a) General. (1) Patients have a right to be treated with dignity in

a humane environment that affords them both reasonable protection from

harm and appropriate privacy with regard to their personal needs.

(2) Patients have a right to receive, to the extent of eligibility

therefor under the law, prompt and appropriate treatment for any

physical or emotional disability.

(3) Patients have the right to the least restrictive conditions

necessary to achieve treatment purposes.

[[Page 633]]

(4) No patient in the Department of Veterans Affairs medical care

system, except as otherwise provided by the applicable State law, shall

be denied legal rights solely by virtue of being voluntarily admitted or

involuntarily committed. Such legal rights include, but are not limited

to, the following:

(i) The right to hold and to dispose of property except as may be

limited in accordance with paragraph ©(2) of this section;

(ii) The right to execute legal instruments (e.g., will);

(iii) The right to enter into contractual relationships;

(iv) The right to register and vote;

(v) The right to marry and to obtain a separation, divorce, or

annulment;

(vi) The right to hold a professional, occupational, or vehicle

operator's license.

(b) Residents and inpatients. Subject to paragraphs © and (d) of

this section, patients admitted on a residential or inpatient care basis

to the Department of Veterans Affairs medical care system have the

following rights:

(1) Visitations and communications. Each patient has the right to

communicate freely and privately with persons outside the facility,

including government officials, attorneys, and clergymen. To facilitate

these communications each patient shall be provided the opportunity to

meet with visitors during regularly scheduled visiting hours, convenient

and reasonable access to public telephones for making and receiving

phone calls, and the opportunity to send and receive unopened mail.

(i) Communications with attorneys, law enforcement agencies, or

government officials and representatives of recognized service

organizations when the latter are acting as agents for the patient in a

matter concerning Department of Veterans Affairs benfits, shall not be

reviewed.

(ii) A patient may refuse visitors.

(iii) If a patient's right to receive unopened mail is restricted

pursuant to paragraph © of this section, the patient shall be required

to open the sealed mail while in the presence of an appropriate person

for the sole purpose of ascertaining whether the mail contains

contraband material, i.e., implements which pose significant risk of

bodily harm to the patient or others or any drugs or medication. Any

such material will be held for the patient or disposed of in accordance

with instructions concerning patients' mail published by the Veterans

Health Administration, Department of Veterans Affairs, and/or the local

health care facility.

(iv) Each patient shall be afforded the opportunity to purchase, at

the patient's expense, letter writing material including stamps. In the

event a patient needs assistance in purchasing writing material, or in

writing, reading or sending mail, the medical facility will attempt, at

the patient's request, to provide such assistance by means of

volunteers, sufficient to mail at least one (1) letter each week.

(v) All information gained by staff personnel of a medical facility

during the course of assisting a patient in writing, reading, or sending

mail is to be kept strictly confidential except for any disclosure

required by law.

(2) Clothing. Each patient has the right to wear his or her own

clothing.

(3) Personal Possessions. Each patient has the right to keep and use

his or her own personal possessions consistent with available space,

governing fire safety regulations, restrictions on noise, and

restrictions on possession of contraband material, drugs and

medications.

(4) Money. Each patient has the right to keep and spend his or her

own money and to have access to funds in his or her account in

accordance with instructions concerning personal funds of patients

published by the Veterans Health Administration.

(5) Social Interaction. Each patient has the right to social

interaction with others.

(6) Exercise. Each patient has the right to regular physical

exercise and to be outdoors at regular and frequent intervals.

Facilities and equipment for such exercise shall be provided.

(7) Worship. The opportunity for religious worship shall be made

available to each patient who desires such opportunity. No patient will

be coerced into engaging in any religious activities against his or her

desires.

[[Page 634]]

© Restrictions. (1) A right set forth in paragraph (b) of this

section may be restricted within the patient's treatment plan by written

order signed by the appropriate health care professional if--

(i) It is determined pursuant to paragraph ©(2) of this section

that a valid and sufficient reason exists for a restriction, and

(ii) The order imposing the restriction and a progress note

detailing the indications therefor are both entered into the patient's

permanent medical record.

(2) For the purpose of paragraph © of this section, a valid and

sufficient reason exists when, after consideration of pertinent facts,

including the patient's history, current condition and prognosis, a

health care professional reasonably believes that the full exercise of

the specific right would--

(i) Adversely affect the patient's physical or mental health,

(ii) Under prevailing community standards, likely stigmatize the

patient's reputation to a degree that would adversely affect the

patient's return to independent living,

(iii) Significantly infringe upon the rights of or jeopardize the

health or safety of others, or

(iv) Have a significant adverse impact on the operation of the

medical facility, to such an extent that the patient's exercise of the

specific right should be restricted. In determining whether a patient's

specific right should be restricted, the health care professional

concerned must determine that the likelihood and seriousness of the

consequences that are expected to result from the full exercise of the

right are so compelling as to warrant the restriction. The Chief of

Service or Chief of Staff, as designated by local policy, should concur

with the decision to impose such restriction. In this connection, it

should be noted that there is no intention to imply that each of the

reasons specified in paragraphs ©(2)(i) through (iv) of this section

are logically relevant to each of the rights set forth in paragraph

(b)(1) of this section.

(3) If it has been determined under paragraph ©(2) of this section

that a valid and sufficient reason exists for restricting any of the

patient's rights set forth in paragraph (b) of this section, the least

restrictive method for protecting the interest or interests specified in

paragraphs ©(2)(i) through (iv) of this section that are involved

shall be employed.

(4) The patient must be promptly notified of any restriction imposed

under paragraph © of this section and the reasons therefor.

(5) All restricting orders under paragraph © of this section must

be reviewed at least once every 30 days by the practitioner and must be

concurred in by the Chief of Service or Chief of Staff.

(d) Restraint and seclusion of patients. (1) Each patient has the

right to be free from physical restraint or seclusion except in

situations in which there is a substantial risk of imminent harm by the

patient to himself, herself, or others and less restrictive means of

preventing such harm have been determined to be inappropriate or

insufficient. Patients will be physically restrained or placed in

seclusion only on the written order of an appropriate licensed health

care professional. The reason for any restraint order will be clearly

documented in the progress notes of the patient's medical record. The

written order may be entered on the basis of telephonic authority, but

in such an event, an appropriate licensed health care professional must

examine the patient and sign a written order within an appropriate

timeframe that is in compliance with current community and/or

accreditation standards. In emergency situations, where inability to

contact an appropriate licensed health care professional prior to

restraint is likely to result in immediate harm to the patient or

others, the patient may be temporarily restrained by a member of the

staff until appropriate authorization can be received from an

appropriate licensed health care professional . Use of restraints or

seclusion may continue for a period of time that does not exceed current

community and/or accreditation standards, within which time an

appropriate licensed health care professional shall again be consulted

to determine if continuance of such restraint or seclusion is required.

Restraint or seclusion may not be used as

[[Page 635]]

a punishment, for the convenience of staff, or as a substitute for

treatment programs.

(2) While in restraint or seclusion, the patient must be seen within

appropriate timeframes in compliance with current community and/or

accreditation standards:

(i) By an appropriate health care professional who will monitor and

chart the patient's physical and mental condition; and

(ii) By other ward personnel as frequently as is reasonable under

existing circumstances.

(3) Each patient in restraint or seclusion shall have bathroom

privileges according to his or her needs.

(4) Each patient in restraint or seclusion shall have the

opportunity to bathe at least every twenty-four (24) hours.

(5) Each patient in restraint or seclusion shall be provided

nutrition and fluid appropriately.

(e) Medication. Patients have a right to be free from unnecessary or

excessive medication. Except in an emergency, medication will be

administered only on a written order of an appropriate health care

professional in that patient's medical record. The written order may be

entered on the basis of telephonic authority received from an

appropriate health care professional, but in such event, the written

order must be countersigned by an appropriate health care professional

within 24 hours of the ordering of the medication. An appropriate health

care professional will be responsible for all medication given or

administered to a patient. A review by an appropriate health care

professional of the drug regimen of each inpatient shall take place at

least every thirty (30) days. It is recognized that administration of

certain medications will be reviewed more frequently. Medication shall

not be used as punishment, for the convenience of the staff, or in

quantities which interfere with the patient's treatment program.

(f) Confidentiality. Information gained by staff from the patient or

the patient's medical record will be kept confidential and will not be

disclosed except in accordance with applicable law.

(g) Patient grievances. Each patient has the right to present

grievances with respect to perceived infringement of the rights

described in this section or concerning any other matter on behalf of

himself, herself or others, to staff members at the facility in which

the patient is receiving care, other Department of Veterans Affairs

officials, government officials, members of Congress or any other person

without fear or reprisal.

(h) Notice of patient's rights. Upon the admission of any patient,

the patient or his/her representative shall be informed of the rights

described in this section, shall be given a copy of a statement of those

rights and shall be informed of the fact that the statement of rights is

posted at each nursing station. All staff members assigned to work with

patients will be given a copy of the statement of rights and these

rights will be discussed with them by their immediate supervisor.

(i) Other rights. The rights described in this section are in

addition to and not in derogation of any statutory, constitutional or

other legal rights.

(Authority: 38 U.S.C. 501, 1721)

[47 FR 55486, Dec. 10, 1982. Redesignated at 61 FR 21965, May 13, 1996,

as amended at 70 FR 67094, Nov. 4, 2005]

Tentative Eligibility Determinations