Applies to: Any recipient of state or county funding in an in-patient facility who is receiving services for mental illness, a developmental disability, or substance abuse in the state of Wisconsin.
Under Sec. 51.61(2) Wisconsin Statutes (exit DHS; PDF, scroll to page 53, bottom left) - State Alcohol, Drug Abuse, Developmental Disability and Mental Health Act, certain rights of inpatients may be denied for treatment, management, or security reasons. They are:
- The right to make and receive telephone calls
- The right to wear one’s own clothing and use one’s own possessions
- The right to secure storage space
- The right to privacy in toileting and bathing
- The right to see visitors
These are the ONLY rights that may be limited or denied through this process.
A right cannot be denied even though the limitation would accomplish an intended treatment goal. Rights limits can be imposed only for as long as they are necessary to protect the treatment, management or security interest involved.
DHS 94.05 Patient Rights and Resolution of Patient Grievances. (exit DHS; PDF, scroll to page 3)
Some limitations can be long-term, however, if an individual continues to pose a danger to him or herself or others.
The law requires that any limits or denials of rights be documented. Staff of state-operated facilities are required by policy to use the form created for this purpose.
Client Rights Limitation or Denial Documentation F-26100 (PDF, 60KB)
F-26100S Client Rights Limitation or Denial Documentation - Spanish (PDF, 60KB)
All other treatment providers are encouraged to use this form since it meets the documentation standards of the law. Instructions for completing F-26100 come with the form.
Rights limitations must be reviewed periodically by facility staff to see if they are still necessary.
At hospitals accredited by the Joint Commission for the Accreditation of Hospital Organizations (JCAHO), limits on phone calls and visitors must be reviewed weekly.
There is space on the form for documenting the reviews. If a limitation is long-term, the following form can be used to document ongoing additional reviews.
Client Rights Limitation or Denial Documentation Review Schedule Supplement F-26100A (PDF, 54KB)
The individual whose rights are limited or denied (or his or her guardian) must be given a copy of the documentation or form F26100.
Within two calendar days, copies of the rights limitation documentation must also be provided to the facility’s Client Rights Specialist and, if the individual is a county department patient, to the county’s Client Rights Specialist.
See DHS 94.05(4) Patient Rights and Resolution of Patient Grievances (exit DHS; PDF - scroll to page 3)
Besides the rights listed above which may be limited or denied using the CRLD process, there may be other occasions when a service provider is considering limiting a client's rights.
There are circumstances where rights may be limited or denied for a variety of reasons under the client rights laws and code.
The following exceptions to rights should be reviewed in such circumstances to see if the right may be limited or denied other than through the CRLD process.
If there are no exceptions, then the right cannot be limited or denied. Even when exceptions do apply, the least restrictive measure must be taken.
Please note that the exceptions listed below are only a quick summary of the rights and their exceptions. Please refer to the Community Grievance Decision Digest for the complete law and rule by topic.
The Digest also summarizes the grievance decisions that have been made under that section of the laws and rules. ["Inpatient" means any client receiving services in a residential setting.]
Other rights exceptions: This is a list of other client rights and what exceptions, if any, can be imposed upon them. Any limits under these rights must be documented in the client's treatment records, but do not need a CRLD form filled out since they are not part of Section 51.61(2), Stats.
|Right to:||Exceptions: (Can limit/deny for:)|
|Accusations - opportunity to refute||None - everyone should be have the chance to refute an allegation of a rule violation or claim mitigating circumstances|
|Arbitrary decisions not allowed||None - all decisions about clients must be rationally based on a legitimate treatment, management, or security reason.|
|Businesses - conducting own||Inpatients may conduct any legitimate business, so long as it does not interfere with treatment, the orderly operation of facility, security, or other clients' rights.|
|Community access||Inpatients should be allowed access to the community except for individualized security or safety reason.|
|Confidentiality of records||All records are confidential and can only be released with written consent, but there are 31 specific exceptions to the informed consent requirement listed in ss. 51.30(4)(b), Wis. Stats.|
|Diet - nutritional diet and reasonable food choices||None - Inpatients must be provided a balanced, nutritional diet.|
|Diets - religious, cultural, personal||Inpatients are entitled to pursue their own religious or cultural diets or personal (like vegetarian) diets as can be provided.|
|Dignity and respect||All clients must be treated with respect and recognition of their dignity and individuality by all employees and by health care providers they meet..|
|Discipline - rule notice required||None - Rules should be in writing, but staff can verbally inform clients of rules and the possible consequences of violating those rules. It is harder to show actual notice if the rules are not in writing. Post them!|
|Drastic treatment - freedom from||None - Clients can refuse any drastic treatment procedures.|
|Environment must be clean and safe||None - All inpatient facilities must be designed to be clean and safe.|
|Exercise opportunities||All inpatients must be given the opportunity for reasonable & regular exercise.|
|Filming or taping w/o consent||All filming or taping requires consent, but a facility can monitor common areas with cameras, they just cannot tape. A picture of the client can be taken for the treatment record.|
|Funds - using one's own||All clients should be able to use their own funds as they wish - except for any guardianship and/or payee limitations. Inpatient facilities can limit the amount of cash that clients can possess.|
|Grooming / hygiene items access||Inpatients should have access to grooming items. However, if there is a safety issue involved, the right to possess such items can be limited by policy for a group of patients (e.g. staff keep razors for clients) or individually through the CRLD process if there is an item that one person cannot handle without supervision.|
|Informed of rights||All clients must be informed of their rights on admission, but this can be postponed for a short while if the client is not capable of understanding them upon admission. Annual re-notification must be given to long-term clients.|
|Informed of costs of care||All clients must be informed of the costs of their care on admission, but the service provider can give general costs (e.g. hourly) and an estimate of total costs.|
|Labor of financial benefit to facility||Clients performing such labor must consent to it and be paid at least minimum wage.|
|Labor- personal housekeeping||Inpatients can be expected to clean up after themselves and do light housekeeping work if the work is shared equally among clients.|
|Legal access to courts/ attorneys||No exceptions, but there may be extreme circumstances where legal calls, for instance, can be limited. Providers should seek legal advice for any such limits.|
|Mail - incoming, outgoing||(Except for those held under a Chapter 980) Patients have a right to send and receive sealed mail. Mail can be opened (if it is not "legal mail") if there is probable cause to believe the letter may contain contraband. Otherwise, sending/receiving mail can be limited only by court order or consent of the client or guardian.|
|Meal times - 30 minutes to eat||Inpatients must be given the full half-hour to eat unless it is contraindicated for individuals for documented reasons.|
|Media access to TV, radio, etc.||Inpatients must have access to the media unless there is a documented safety or security reason for limiting the access.|
|Meds - no excessive, unnecessary||Medications must be appropriate to the client's condition and in dosages within normal ranges. Any deviations from that need to be well-documented by a physician.|
|Musical instruments||Inpatients should be given the opportunity to use their own guitar, etc., except for documented safety or security reasons. Time & place limits may be imposed.|
|Off-unit exercise||Inpatients should be given access to exercise and other off-unit activities unless there are documented, individualized security or safety reasons for not allowing.|
|Outdoor access- regular & frequent||Can only limit for health reasons or for documented, individualized security reasons. Where necessary, the outdoor access can be supervised.|
|Recreation opportunities||Inpatients should be given access to recreational activities except for individualized security or safety reasons.|
|Refusing treatment or meds||Clients can refuse all treatment and medications (except in an emergency) unless court ordered.|
|Religious worship||Inpatients should be allowed to attend on-unit religious activities unless they display disruptive behavior.|
|Religious worship off the unit||Inpatients should also be allowed to attend off-unit religious activities unless there are documented security reasons for not allowing them to go.|
|Research||Clients have to give their written, informed consent for all techniques used on them..|
|Restraint - freedom from||Clients cannot be restrained except in an emergency when it is likely they pose a danger to self or others. Restraint must be used for the shortest time possible.|
|Room decorations||Inpatients should be allowed to decorate their own rooms in any way they wish, but they don't have the right to display offensive or gang-related décor. An inpatient facility can restrict areas for clients who want to display sexually explicit materials (e.g. on the back of their room door where staff don't have to see it.)|
|Self-expression through art, music, etc.||Inpatient should be allowed to express themselves artistically unless there are documented safeties of security reasons for limiting it.|
|Safety||Staff must protect inpatients from safety hazards, including other patients.|
|Searches of the person||Only inpatients may be subject to personal searches. (See DHS 94.24(2)(d)1).|
|Search of a client's room||Only inpatients can be subject to a search of their rooms and only where there is "probable cause" to believe security rules have been violated. (See DHS 94.24(2)(e))|
|Seclusion - freedom from||Clients cannot be secluded unless in an emergency where it is likely they will pose a danger to self or others. Seclusion must be used for the shortest time possible.|
|Snacks||Snacks must be accessible to inpatients, except when contraindicated for individual clients.|
|Social contact with members of the opposite sex||Inpatients should be allowed to mix with the opposite sex unless there are treatment, safety or security reasons for limiting it.|
|Toilet access||Access to a toilet and sink must be unscheduled, except a client in seclusion must be allowed access every 30 minutes.|
|Treatment participation||All clients should participate in the planning of their treatment and care, but the client does not necessarily get to "pick and choose" the parts of the plan the client likes best. The client's treatment team makes the final decisions about what is the most appropriate treatment. The client can refuse the treatment or ask for a second opinion if they disagree.|
|Treatment - prompt & adequate||All clients are entitled to treatment that is appropriate to their condition and delivered promptly and adequately.|
|TV, radio, etc - buying their own||Inpatients should be allowed to purchase their own TV's, etc., but this can be limited per policy for security, or safety reasons.|
Reminder: the above exceptions are only a quick summary of the rights and their exceptions. Please refer to the Community Grievance Decision Digest for the complete law and rule by topic.