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Patient Rights and the Grievance Procedure

What are “Patient Rights”?

According to Wisconsin law, “patient rights” apply to any individual who is receiving services for mental illness, developmental disability, or alcohol or drug abuse. These rights cover people who are voluntary patients, involuntary patients, forensic patients, people who are in community treatment programs, people who are in hospitals or residential facilities, people who are private pay, meaning their own insurance is paying for their care, or people whose care is being paid for by a state or county agency. Patient rights come from Sec. 51.61 of the Wisconsin Statutes and Chapter HFS 94 of the Wisconsin Administrative Code.

Treatment rights include the right to prompt and adequate treatment in the least restrictive environment, the right to give informed consent for treatment and medication and the right to not be unduly subjected to seclusion or restraints.

Rights relating to privacy include confidentiality and access to one’s own records.

Communication rights include access to the telephone to make and receive private calls, the ability to meet with visitors and the right to receive and send sealed mail.

Personal rights include the right to be treated with respect and dignity, the right to be treated in a humane environment and the right to personal choice regarding religious worship.

Financial rights include being compensated for one’s labor, being informed of any charges for treatment and the right to manage one’s own money.

What is a Grievance Procedure?

A grievance procedure is a way for an individual to address what he or she believes to be a violation of any of the patient rights. Programs must have a written document describing the grievance process which may be used by consumers who wish to file a grievance against a program. There must be an informal way to resolve grievances as well as a formal grievance procedure. State regulations describe how the grievance procedure is supposed to work.

Who May File a Grievance?

A client of a program providing services for mental illness, developmental disabilities, or alcohol or drug abuse may file a grievance concerning what he or she believes is a violation of patient rights. A guardian, parent or anyone else aware of a patient rights violation may also file a grievance. No one who files a grievance may be retaliated against for doing so.

How is a Grievance Filed?

The person with the grievance can tell any staff member of the program that he or she wants to file a grievance. The staff member will provide the person the program’s grievance form or contact the program’s Client Rights Specialist to help the person. Alternatively, the person can write out the grievance and give it to a staff member or the Client Rights Specialist. It will help with the investigation of the grievance if the person is fairly clear about what happened, who was involved, what documents exist regarding the incident and so forth.

What is a Client Rights Specialist?

All programs must have a Client Rights Specialist (CRS) to work with consumers who file grievances. It is the job of the Client Rights Specialist to meet with the consumer to assist him or her with filing a grievance. The CRS must investigate the grievance by meeting with the consumer and any parties involved in the grieved incident, reviewing records and other materials and taking other needed actions. A Clients Rights Specialist cannot have any involvement in the incident which the client is complaining about.

How Does Wisconsin’s Grievance Procedure Work?

The grievance procedure, as spelled out in state regulations, puts an emphasis on informal resolution of grievances if at all possible. Consumers are encouraged, though not required, to meet with people to try to work things out before getting into the more formal procedures. Also, at any time during the formal grievance process, informal means such as meetings, mediation, etc. can be used and the time limit for the formal process will be suspended while people try to resolve their concerns.

If informal methods do not work, then the formal grievance process may be used. A grievance must be filed with the program where the problem arose within 45 days of the event, unless there is a good reason for needing more time. The program is the clinic, hospital, community support program, group home, etc. where the person is receiving services.

LEVELS OF REVIEW

There are four levels to Wisconsin’s grievance procedure. This means that if you feel that your grievance wasn’t resolved to your satisfaction at the first level (the program, for example), you may take it to the next level.

Program Level Review

At the program level a Client Rights Specialist (CRS) will investigate the grievance and write a report within 30 days of receiving the grievance. This report must state his/her understanding of the facts, a finding of whether a patient rights violation occurred, and if so, recommendations for resolving the grievance. This report must be given to the consumer, the grievant if other than the consumer, involved staff members and the manager of the program. If everyone agrees with the report, then any recommendations made by the CRS are to be put into effect. If there is disagreement, the program manager and CRS will try to resolve the issues with the parties. If this is not possible, the program manager must prepare a written decision which will be the official position of the program. He or she must do this within 10 days of receiving the report from the CRS. Thus, if you disagree with the report of the CRS, you should let the CRS or the program manager know as soon as possible after receiving the report from the CRS.

Administrative Review

The program manager’s decision can be appealed by the consumer or grievant to the county level if the program is operated by or has a contract with the county. This means that the director of the county Department of Human Services or community programs or his/her designee will review the grievance. If the program is not operated by or under contract with the county, the program manager’s decision may be appealed to the state grievance examiner, who is an employee of the Department of Health & Family Services. An appeal must be filed within 14 days of receiving the program manager’s decision. The request for appeal must be given to the program manager and it must state the reason for objecting to his/her decision. The program manager must forward the appeal and all relevant documents to the appropriate county or state reviewer.

When a request for an administrative review (or appeal) is made, the county agency representative or the state grievance examiner may conduct further investigation. The grievant can request to speak to the county agency representative or state grievance examiner to explain the issues. After reading the documents from the program level review and conducting any further investigation, the county agency representative or state grievance examiner must write a report which states his/her understanding of the facts, a finding about whether a patient rights violation occurred, and if so, actions to resolve the problem. This report must be completed within 30 days of the appeal, with a 30-day extension if agreed to by the parties to the grievance. The report, along with information about how to appeal to the next stage, must be sent to the consumer, the grievant, Client Rights Specialist, program manager and relevant program staff.

State Level Review

The decision of the director of the county Department of Human Services or community programs can be appealed by the consumer, grievant or program manager to the state grievance examiner. This request must be made within 14 days of receiving the county director’s decision. If the grievant or consumer wants to appeal, he or she notifies the program manager, who is responsible for sending the appeal and all relevant documents to the state.

The state grievance examiner may conduct additional investigations and talk with the grievant if requested or if the examiner determines it is needed. He or she must issue a written report setting forth his/her findings within 30 days, unless a 30-day extension was agreed to by all the parties. A copy of this report, along with information about how to appeal, must be sent to the consumer, grievant, program director, Client Rights Specialist and county director.

Final State Review

Any decision of the state grievance examiner may be appealed to the Administrator of the Division of Supportive Living at the state Department of Health & Family Services. This appeal must be filed within 14 days of receipt of the state grievance examiner’s decision. The grievant should ask the program manager to file the appeal. The Division Administrator must review all the relevant material and make a decision within 30 days, unless a 30-day extension has been granted. His or her decision is final.

What Happens in an Emergency?

The state regulations define an emergency as a situation where there is reasonable cause to believe that a client(s) is at significant risk of physical or emotional harm due to circumstances identified in the grievance. In this case, all the time frames for conducting investigations and making decisions are significantly shortened.

What if the Program or County Grievance Procedure Does Not Meet State Requirements?

Clients or other interested persons may file a complaint about the operation of the grievance procedure with the state grievance examiner. He/she must conduct an investigation and issue a report identifying any problems and steps which need to be taken to meet state regulations. If the program fails to make changes, the matter will be referred to the appropriate state regulatory body.

Can a Consumer Go to Court Instead of Filing a Grievance?

A lawsuit concerning a patient rights violation may be filed instead of using the grievance procedure. A person is not required to go through the grievance procedure before going to court. However, once a lawsuit is filed, the processing of the grievance usually will stop.