Pa. Code 5100.54

Manual of rights for persons in treatment

This regulation establishes a comprehensive manual of rights for persons receiving mental health treatment in Pennsylvania facilities, covering communication, religious freedom, personal affairs, humane environment, treatment, and grievance procedures. Facility operators must provide patients with information about their rights, ensure access to attorneys and visitors, follow specific protocols for restricting rights, maintain individualized treatment plans, and operate a formal grievance and appeal system. The manual applies to both State-operated and non-State (community) mental health facilities and governs permissible, restricted, and prohibited treatment procedures including restraints, ECT, and experimental treatments.

55 Pa. Code § 5100.54 - Manual of rights for persons in treatment 

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The following is the manual of rights for persons in
 treatment:

Article I: 
The Right to
 Communicate

Statement of Principle

1.
 Right to Information

2.
 Right to Assistance

3.
 Right to an Attorney

4.
 Right to Have Visitors

5.
 Right to Send and Receive
 Letters

6.
 Right to Use
 Telephones

Article II: 
The Right of Religious
 Freedom

Statement of Principle

1.
 Right to Refuse Medication

2.
 Right to Diets Based on Religious or
 Ethical Consideration

3.
 Right to
 Abstain from Religious Practices

Article III:
The Right to Handle Your Personal
 Affairs

Article IV:
The Right to a Humane Physical and
 Psychological Environment

Article V: 
The Right to Treatment

Statement of Principle

1.
 Individualized Treatment Plan

2.
 Discharge

Article VI: 
Permissible, Restricted and
 Prohibited Treatment Procedures

Statement of Principle

1.
 Permissible Procedures

2.
 Restricted Procedures

3.
 Prohibited Procedures

Article VII: 
Grievance and Appeal
 Procedures

Statement of Principle

1.
 Grievance Procedures

2.
 First Level Appeal

3.
 Second Level Appeal

ARTICLE I

THE RIGHT TO COMMUNICATE

Statement of Principle.

(a)
 Every patient has the right and shall be
 encouraged to communicate freely and privately with others within the facility
 and in the community at large, as described below. This is based upon the firm
 belief that meaningful communications are essential to a successful course of
 treatment. These rights may be suspended or restricted for a limited period by
 the treating physician only when reasonable cause exists to believe that
 failure to suspend communications will result in a substantial risk of serious
 and immediate harm to the patient or others, or that a crime is being
 committed. The physician shall fully explain any suspensions or restrictions of
 these rights to the patient and document the reasons for the restriction in the
 patient's record. Suspension or restrictions shall be reviewed and documented
 every 48 hours until the risk of serious and immediate harm is
 reduced.

(b)
 Every patient shall
 have the right to make complaints and offer suggestions to the director, or his
 designee, regarding the operation of the facility, and may meet with other
 patients to discuss their concerns with facility administrators. Complaints and
 suggestions shall be heard and decided promptly. 
 
1.
 Right to Information. 
 
(a)
 Every patient has the right to be
 informed of his rights and responsibilities while in treatment, and those house
 rules and regulations of the facility which affect his treatment.

(b)
 Every patient has the right to be
 informed of diagnostic and treatment procedures, their risks and their costs,
 that are available to him and which would aid in his recovery from mental
 illness. Patients have the right to be informed of the reasons and factors
 involved in recommending a procedure of choice.

(c)
 Every patient has the right to be
 informed of the nature of material about to be released to others (or obtained)
 when he is requested to sign a release of information.

2.
 Right to Assistance. 
 
(a)
 Every patient shall have the right to the
 assistance of an independent person not a member of his treatment team to
 resolve a problem raised by the patient.

(b)
 Each non-State facility shall designate
 one or more persons either on a volunteer or staff basis as needed to help
 patients in this manner.

(c)
 State
 facilities shall designate one or more staff to aid patients, and these persons
 shall be accessible during regular working hours.

(d)
 Every State facility shall advise and
 educate all patients about the availability and services of this
 program.

(e)
 These persons will be
 responsible for assisting or supporting the patient in meeting with the
 appropriate person to discuss the problem and possible solution. They shall
 maintain a confidential file of requests for service and subsequent actions
 taken. The file shall be open to review only by the facility director or the
 patient's Attorney and shall be filed with the patient's clinical record upon
 discharge. They have no authority to directly resolve problems but may report
 his or her findings directly to the facility director.

3.
 Right to an Attorney. 
 
(a)
 Every patient has the right to retain an
 attorney of his choice to assist the patient in asserting his rights to
 treatment or release or to aid the patient in any other matter.

(b)
 The facility will provide patients with
 referral information and other non-monetary assistance to enable patients to
 implement this right. The names, addresses and telephone numbers of legal
 services and other available advocates in this area shall be given to all
 patients.

(c)
 Every patient has the
 right to see or telephone his attorney in private at any reasonable time,
 regardless of visiting hours.

4.
 Right to Have Visitors. 
 
(a)
 Every patient has the right to receive
 visitors of his own choice daily, within established visiting hours, in a
 setting of reasonable privacy conducive to free and open conversation unless a
 visitor or visitors are determined to seriously interfere with a patient's
 treatment or welfare.

(b)

 Established visiting hours shall attempt to meet the needs of individual
 patients and visitors, and may be waived to the extent feasible to accommodate
 special circumstances or the needs of individual patients.

5.
 Right to Send and Receive Letters. 
 
(a)
 Every patient has the right to send
 unopened mail. Reasonable amounts of such mail shall be stamped free of charge
 if sufficient personal funds are not available.

(b)
 Writing materials shall be made available
 to patients on a daily basis and an opportunity provided for writing letters
 and other communications. Reasonable assistance shall be provided upon request,
 if feasible.

(c)
 Incoming mail may
 be opened only when there is reason to suspect it contains contraband, and in
 the presence of the patient unless dangerous or infeasible in the light of the
 patient's condition. Contraband is specific property, the possession or use of
 which is illegal or entails a substantial threat to the health and welfare of
 the patient or the hospital community.

(d)
 Whenever mail is opened on suspicion of
 contraband, an identification of the person opening the mail, a statement of
 the facts constituting good cause, and the results of the opening including
 disposition shall be noted in the patient's record.

(e)
 A patient's mail, whether incoming or
 outgoing, shall not be read under any circumstances, unless at the patient's
 request.

6.
 Right to Use
 Telephones.
(a)
 Every patient has the right to
 make telephone calls at his own expense, at reasonable times, using telephones
 designated for patient or public use. The facility shall take steps to provide
 sufficient telephones.

(b)
 In cases
 of personal emergency, when alternative methods of communication are
 impractical, every patient shall have the right to make reasonable local and
 long distance phone calls, free of charge. These calls shall be subject to
 reimbursement if the patient has sufficient funds to pay for the call. The
 director of the facility, or his delegate, shall determine what constitutes
 personal emergency.

ARTICLE II THE RIGHT TO RELIGIOUS FREEDOM

Statement of Principle.

Every patient has the right to follow and practice his
 religion. Substantiated ethical convictions held independently of a belief in
 any religion shall be accorded the same respect as religious belief. The
 facilty shall provide reasonable assistance to enable a patient to effect this
 right.

The exercise of these rights may be limited only if it
 poses a serious threat to the freedom or welfare of others, or a serious danger
 to the patient.

1.
 Right to Refuse
 Medication. 
 
Any patient who holds a substantiated belief in the power
 of spiritual healing shall not be compelled to take medication, provided the
 patient is intellectually capable of understanding the impact of such refusal
 and of deciding to refuse medication.

 2.
 Right to Diets Based on Religious Considerations. 
 
The patient's right to independently comply with his or
 her dietary regimen shall not be interfered with by the facility unless
 unfeasible or unless there is serious danger to a person's health.

3.
 Right to Abstain from
 Religious Practices. 
 
No patient shall be required to be pressured directly or
 indirectly to participate in religious practices. No patient shall be compelled
 to accept visitation from a clergyman or minister of any
 religion.

ARTICLE III THE RIGHT TO HANDLE YOUR PERSONAL AFFAIRS

Statement of Principle.

Every patient retains all civil rights not specifically
 curtailed by an order of a court or other body empowered to take such action.

(a)
 Every patient has the right to
 handle his personal affairs. Admission or commitment to a mental health
 facility does not by itself, prevent a patient from holding a driver's license
 or professional license, from marrying or obtaining a divorce, from voting or
 writing a will, or exercising other civil and personal rights; nor is the
 patient guaranteed the ability to exercise any of these rights.

(b)
 Every patient has the right to purchase,
 keep, and use personal possessions. This right may be limited only when the
 possession or use of specific property is illegal or creates a substantial
 threat to the health or welfare of the patient or others. The reasons for
 imposing any limitations on the exercise of this right and the scope of such
 limitation shall be clearly explained to the patient and placed in the
 patient's record.

(c)
 Every patient
 has the right to sell or retain any product or crop he makes, or grows on
 facility property. Money received from these activities shall not be used to
 pay the costs of any patient's care and treatment.

(d)
 A patient shall not be deemed incompetent
 to manage his own affairs solely by reason of admission or commitment to a
 mental health facility. 
 
A court finding of incompetency may not be extended
 beyond the specific scope of the court order.

ARTICLE IV RIGHT TO A HUMANE PHYSICAL AND PSYCHOLOGICAL
 ENVIRONMENT

Statement of Principle.

Every patient has the right to reside and be treated in a
 setting which preserves and promotes his physical and psychological dignity.

(a)
 Every patient has the right to be
 treated humanely and with consideration by all staff members. Any grossly
 negligent or intentional conduct of staff which causes or may cause emotional
 or physical harm to a patient is a violation of this right.

(b)
 Every patient has the right to assistance
 in developing a physical appearance which promotes a positive self image. This
 includes the following:
(1)
 The right to keep
 and wear his own clothing, unless there are reasonable grounds to believe such
 clothing or specific items constitute a substantial threat to the health or
 safety of the patient or others.

(2)
 Clothing provided by the facility shall
 be neat, clean, appropriate to the season and to the extent possible,
 consistent with the patient's personal preference. This clothing shall enable
 the patient to make a customary appearance within the community.

(3)
 The right to purchase, keep, and use
 customary cosmetic, hygiene, and grooming articles or services unless there are
 reasonable grounds to believe specific articles constitute a substantial threat
 to the health or safety of the patient or others.

(4)
 Basic customary cosmetic, hygiene, and
 grooming articles or services shall be provided by the facility for patients
 who need them but cannot afford them. Patients shall be given reasonable
 assistance as needed in utilizing cosmetic, hygiene, and grooming articles and
 services.

(c)
 Every
 residential patient shall be furnished with a comfortable bed and bedding,
 adequate change of linen, a closet or locker for personal belongings, and a
 bedside cabinet. Every patient, at his or her own risk, shall be allowed to
 keep and display appropriate personal belongings and to add personal touches to
 his room or living area.

(d)
 Every
 patient has the right to a nutritionally adequate diet and every patient has
 the right to eat or to be fed under supervision, in the dining room or area in
 the relaxed atmosphere, and to use normal eating implements, unless
 contra-indicated by the patient's conduct or course of treatment.

(e)
 Every patient has the right to bathroom
 facilities which provide privacy for personal hygiene and meet Departmental
 standards for health, safety, and cleanliness.

(f)
 Every patient has the right to
 therapeutic and daily living activities held in settings that approximate
 noninstitutional living. Dining, recreational, vocational, and other activities
 shall where possible and appropriate be conducted on a basis which provides
 interaction between male and female patients.

ARTICLE V RIGHT TO TREATMENT

Statement of Principle.

Every patient has the right to receive treatment designed
 to aid and promote his recovery from mental illness. This treatment shall,
 whenever possible, be in or near the patient's home community, and shall be in
 the least restrictive setting available to provide adequate treatment or to
 meet the conditions of security imposed by a court.

1.
 Individual Treatment Plan. 
 
(a)
 Every patient has the right to an
 individualized treatment plan, appropriate to his needs, setting forth the
 objectives, goals, activities, experiences, and therapies designed to promote
 recovery.

(b)
 The plan shall be
 developed within 72 hours of admission or commitment. It shall be revised
 whenever necessary and reviewed at least every 30 days.

(c)
 Every patient has the right to
 participate to the extent feasible in the development of his treatment plan.
 The plan shall be written in terms understandable by lay persons and shall be
 explained to the patient. A copy of the treatment plan shall be made available
 for the patient's review.

2.
 Discharge. 
 
Every patient has the right to be discharged as soon as
 care and treatment is no longer necessary. Every patient has the right to all
 of the available treatment modalties appropriate to his or her needs which
 promote recovery and discharge. Treatment shall also include the appropriate
 post-discharge rehabilitative services available in the
 community.

ARTICLE VI PERMISSIBLE SPECIALIZED AND PROHIBITED
 TREATMENT PROCEDURES

Statement of Principle.

Every patient shall only receive approved treatment
 procedures in accordance with Departmental regulations. This treatment shall be
 described in his individual treatment plan and shall be explained to the
 patient.

1.
 Permissible Procedures. 
 
(a)
 All patients may in an emergency, be
 required to accept the minimal sufficient diagnostic procedures and treatment
 necessary to alleviate the emergency.

(b)
 Patients committed pursuant to sections
 303, 304 or 305 of the act (
50 P. S. §§
 
4303
,
 
4304
, and
 
4305
), may also be required
 to accept routine medical, psychiatric, psychological, and educational programs
 conforming to departmental regulations and the patient's individualized
 treatment plan.

(c)
 Any patient
 committed for examination by court may be required to accept the minimal
 diagnostic procedures necessary to determine the patient's mental
 condition.

(d)
 Any patient in
 treatment on a voluntary basis may agree to participate in any and all approved
 treatment methods as described in his individualized treatment plan. Any
 voluntary patient may also refuse to participate in any aspect of his
 individualized treatment plan and may request a review of the proposed
 treatment. Refusal to accept a reviewed and approved treatment may be cause for
 discharge.

2.
 Specialized
 Procedures.
(a)
 No patient shall be subject to
 the withholding of privileges, nor to any system of rewards, except as part of
 an individualized treatment plan.

(b)
 Electro-convulsive or other therapy,
 experimental treatments involving any risk to the patient, or aversion therapy
 shall not be prescribed unless:
(1)
 The
 patient's treatment team has documented in the patient's record that all
 reasonable and less intensive treatment modalities have been considered; that
 the treatment represents the most effective therapy for the patient at that
 time; and that the patient has been given a full explanation of the nature and
 duration of the proposed treatment and why the treatment team is recommending
 the treatment; and that the patient has been told that he or she has the right
 to accept or refuse the proposed treatment and that if he consents, has the
 right to revoke his consent for any reason at any time prior to or between
 treatments.

(2)
 The treatment was
 recommended by qualified staff members trained and experienced in the treatment
 procedure and has been approved by the facility administrator if an M.D. or, if
 not, by the clinical director after review by the appropriate
 committee.

(3)
 The patient has
 given written informed consent to the specific proposed treatment. In the
 alternative, oral informed consent is sufficient where that consent is
 witnessed by two persons not part of the patient's treatment team. In either
 case, such consent shall be limited to a specified number of maximum treatments
 over a specific period of time and shall be revocable at any time before or
 between treatments. Such withdrawal of consent may be immediately
 effective.

(4)
 If a patient's
 treatment team determines that the patient could benefit from one of those
 specified treatments but also believes that the patient does not have the
 capacity to give informed consent to the treatment, a court order shall be
 obtained authorizing the recommended treatment before such treatment may be
 administered to the patient.

(c)
 No patient shall be subject to chemical,
 physical, or psychological restraints, including seclusion, other than in
 accordance to the Department's regulations applicable to State Mental Health
 Facilities or, in case of community facilities, the policy and procedures for
 seclusion and restraint approved by its medical staff and governing body. A
 copy of the applicable regulations shall be made available to patients upon
 request.

(d)
 No patient shall be
 the subject of any research, unless conducted in strict compliance with Federal
 regulations on the protection of human subjects. Patients considered for
 research approved by the facility shall receive and understand a full
 explanation of the nature of the research, the expected benefit, and the
 potential risk involved. Copies of the Federal regulations shall be made
 available to patients involved in, or considering becoming involved in,
 research or their advocates. Patient research conducted in State facilities or
 funded by State monies requires prior approval of the Deputy Secretary of
 Mental Health.

3.

 Prohibited Procedures. 
 
Psychosurgery, removal of organs for the purpose of
 transplantation, and sterilization, shall not be performed at a State-operated
 mental hospital.

ARTICLE VII GRIEVANCE AND APPEAL PROCEDURES

Statement of Principle.

To insure that these rights are safeguarded and that
 disputes concerning their rights and others are resolved promptly and fairly,
 patients must have the right to lodge grievances and appeals when informal
 methods of resolving disputes are unsuccessful. Each facility shall have a
 grievance and appeal system in effect. Every patient shall be informed of the
 grievance and appeal system and shall be encouraged to utilize it when informal
 methods of resolving complaints are unsuccessful.

1.
 Grievance Procedure. 
 
(a)
 Any patient, or those helping him, may
 initiate a complaint orally or in writing, concerning the exercise of these
 rights or the quality of services and treatment at the facility. The complaint
 shall be presented as soon as possible to the treatment team leader or other
 appropriate person.

(b)
 Every
 patient shall have the right to the assistance of an independent person and
 witnesses in presenting his complaint.

(c)
 The treatment team leader, administrative
 supervisor, or their designees receiving the complaint shall investigate the
 complaint and make every effort to resolve it. Based upon this investigation, a
 decision shall be rendered in writing as soon as possible but within 48 hours
 after the filing of the complaint. Complaints shall be decided by persons not
 directly involved in the circumstances leading to the grievance.

(d)
 The patient shall be given a copy of the
 complaint and final decision and a copy shall be filed in the patient's record.

2.
 First Level Appeal. 
 
(a)
 Any patient, or those helping him, may
 appeal the grievance decision within 10 working days of the decision.
 State-operated facilities shall follow the procedures set forth in this part.
 Non-State operated facilities shall have in effect a fair and impartial appeal
 procedure, which shall be reviewed by the county administrator.

(b)
 In a State-operated facility, standing
 Rights Review Committee composed equally of facility staff and persons from the
 community not affiliated with the facility shall hear the appeal and render a
 written decision within 10 working days of the date of the appeal. Staff
 members shall be appointed by the facility director. Until such time as the
 committee is in effect, the appeal shall be heard by a hearing examiner
 appointed by the regional deputy secretary. If the grievance requires immediate
 action, the appeal shall be heard and decided as soon as possible.

(c)
 The patient shall be given prompt notice
 of the date set for the appeal and shall be informed of his right to be
 represented by counsel.

(d)

 Hearings shall be informal, without strict adherence to the rules of evidence.
 A sufficient record of the hearing shall be made.

(e)
 A copy of the decision shall be given to
 the patient, the facility director, and filed in the patient's
 chart.

3.
 Second Level
 Appeal.
(a)
 Any patient in a State facility,
 those helping him, or the facility director, may appeal the decision of the
 hearing examiner or Rights Review Committee within 10 working days of the
 decision. The appeal must set forth the specific objections to the
 decision.

(b)
 The Secretary of
 Public Welfare shall establish a standing Rights Appeal Committee composed
 equally of Department and community personnel. Within 5 working days of receipt
 of a second level request, the Committee shall review the decision of the
 Rights Review Committee and may seek any additional information it deems
 necessary.

(c)
 The patient shall be
 given prompt notice of the date set for the appeal and shall be informed of his
 or her right to be represented by counsel.

(d)
 Reviews shall be informal. A sufficient
 record of the hearing shall be made.

(e)
 The Committee shall submit a
 recommendation to the Secretary of Public Welfare within 10 working days of its
 receipt of the second level appeal request. The Secretary will review the
 findings and recommendations by the Committee and will issue a
 decision.

(f)
 Nothing in this
 section shall be construed as precluding a patient from instituting appropriate
 legal proceedings.

Notes

55

 Pa. Code §
 
5100.54

This section cited in 55 Pa. Code §
 
5100.4
 (relating to scope); 55 Pa.
 Code §
 
5200.32
 (relating to treatment
 policies and procedures); 55 Pa. Code §
 
5100.52
 (relating to statement of
 principle); 55 Pa. Code §
 
5200.47
 (relating to other
 applicable regulations); 55 Pa. Code §
 
5210.56
 (relating to other
 applicable regulations); 55 Pa. Code §
 
5320.22
 (relating to governing
 body); and 55 Pa. Code §
 
5320.45
 (relating to staff
 orientation and training).

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