Ohio Admin. Code 5122-7-02 - Patient rights within regional psychiatric hospitals

(A) The purpose of this rule shall be is to promote and protect the rights of clients patients receiving services in Ohio's regional psychiatric hospitals (RPHs).

(B) The provisions of this rule shall be applicable apply to all RPHs providing inpatient services under the managing responsibility of the Ohio department of mental health and addiction services (OhioMHAS).

(C) As used in this rule:

(1) "Interested party" means a parent, spouse, other relative, significant other, or guardian of a patient or an advocacy group or interested citizen.

(2) "Patient" means a person who is currently or has received inpatient or outpatient services at or through an RPH.

(D) The policy of OhioMHAS shall be is to promote and protect the rights of clients patients receiving services consistent with a concern for human dignity, respect, recovery, and quality clinical care; to respond promptly and effectively to consumer patient and interested party concerns, inquiries, and complaints, and grievances; and to promote and evaluate consumer patient satisfaction with services provided.

(E) Organization and responsibilities of OhioMHAS' OhioMHAS's advocacy program:

(1) An OhioMHAS client rights and advocacy specialist advocacy services administrator lead for inpatient services shall is to be appointed for the department.

General responsibilities of the OhioMHAS client rights and advocacy specialist advocacy services administrator lead shall include, but are not be limited to, the following:

(a) Providing support for client rights specialists the rights and recovery administrator within the RPHs each RPH;

(b) Serving as the resource person for statewide and individual client patient advocacy issues;

(c) Evaluating and reviewing OhioMHAS policies, procedures, and mechanisms for assurance of client individual rights;

(d) Ensuring that alleged client patient abuse and neglect cases receive prompt and appropriate action;

(e) Promoting liaison with federal, state, local, community, legal, and civil rights advocacy groups;

(f) Consulting with appropriate OhioMHAS staff, including the executive committee team, regarding responses to mediations, complaints, grievances, and grievance appeals, including those having a potential impact on policy development;

(g) Referring matters requiring legal expertise in the area of client patient rights to the department's office of legal services;

(h) Investigating and responding to client patient grievance appeals;

(i) Meeting with RPH client rights specialists rights and recovery administrators on at least a quarterly basis;

(2) Each RPH shall is to have at least one full-time client rights specialist rights and recovery administrator for inpatient services, who reports directly to the RPH chief executive officer (CEO) or the CEO's designee.

Each RPH shall is to have a designated client rights specialist rights and recovery administrator alternate, appointed by the RPH CEO and who reports to the CEO or the CEO's designee.

(3) Duties for the each RPH client rights specialist shall rights and recovery administrator include, but are not limited to, the following:

(a) Planning, implementing, and coordinating RPH advocacy programs, including: ; all of the following:

(i) Mediation;

(ii)(i) Developing policies and procedures for the promotion and protection of human rights in accordance with state and federal statutes, the joint commission guidance, and the centers for medicare and medicaid services, which promote and protect human rights policy;

(iii)(ii) Monitoring and evaluating RPH complianc compliance;

(iv)(iii) Establishing mechanisms for resolution of client patient advocacy problems;

(v)(iv) Providing consultation, mediation negotiation, training, and technical advice; and,

(vi)(v) Representing RPH on matters concerning patient rights.

(b) Providing client patient advocacy services; , including all of the following:

(i) Mediation;

(ii) Assuring that persons served are informed of and have access to mediation services;

(iii)(i) Assuring adequate privacy for client patient interviews;

(iv)(ii) Being accessible to clients patients in person and at work locations;

(v)(iii) Representing and assisting clients patients especially in the areas of rights, abuse and neglect, and fulfillment of recovery and human dignity;

(vi)(iv) Investigating and responding to grievances on behalf of clients patients;

(vii)(v) Attending RPH investigatory interviews with clients patients, as requested by clients patients;

(viii)(vi) Protecting human and civil rights;

(ix)(vii) Reviewing unusual incident reports as part of the quality assurance process;

(x)(viii) Ensuring that clients patients have legal representation at court hearings related to hospital services; and,

(xi)(ix) Ensuring that client patient rights are prominently displayed in writing on every unit.

(c) Attending meetings related to client patient advocacy; serving as a member of the executive governing body and other committees to ensure representation of the hospital's advocacy program; preparing reports for RPH or campus administration and central office; maintaining records; and responding in writing to correspondence pertaining to client patient advocacy;

(d) Providing input into program and environmental changes to meet the needs as identified by clients, patients and assuring protection of patient rights; involvement , as well as being involved in and notification of administrative decisions affecting client patient rights, choice, dignity, and recovery;

(e) Advising all levels of RPH staff and volunteers of client's patient rights; , as well as consulting with appropriate department staff, including legal staff, regarding policy issues and responses to complaints or grievances;

(f) Advocating for clients' patient access to community mental health systems, and facilitating access to other outside entities, including legal counsel, as needed;

(g) Assuring that equal opportunity is implemented with particular emphasis on advocating that people with disabilities are to be free from discrimination in the provision of service services on the basis of religion, race, ethnicity, color, creed, sex, national origin, age, lifestyle, sexual orientation, gender identity, physical or mental handicap, disability, developmental disability, or inability to pay as prescribed in department policies and rules, and state and federal statutes;

(h) Ensuring that each client patient understands the functions of and resources available through the Ohio protection and advocacy system and receives a copy of the patient rights in oral and written format understands their rights and is provided with the client rights in oral and written format, including the functions of and resources available through the Ohio protection and advocacy system, and explanation of their rights as indicated in this paragraph in accordance with all of the following:

(i) The written rights shall are to be furnished to a client patient within twenty-four hours after admission;

(ii) If a client patient is unable to read or speaks a language other than standard English as a primary means of communication, or has a limitation on their ability to communicate effectively, ( such as deafness or hearing impairment), the list of rights shall is to be explained to them by providing interpreters, readers, or appropriate communication devices, or by providing other assistance; and,

(iii) The notification and explanation of client patient rights shall is to be documented in the client's patient's health record.

(4) Compliance with paragraph (E)(3)(h) (D)(3)(h) of this rule shall will be monitored by the RPH quality assurance programs.

Notes

Ohio Admin. Code 5122-7-02

Effective: 8/15/2023
Five Year Review (FYR) Dates: 03/14/2017 and 06/01/2022 and5/17/2023 and 08/15/2028
Promulgated Under: 119.03
Statutory Authority: 5122.33
Rule Amplifies: 5122.29
Prior Effective Dates: 06/05/1978, 07/01/1980, 09/06/1999, 09/18/2010, 06/01/2017