Legal Rights in Hospital And Medical Matters

Persons under 18 years of age with mental illness or emotional disorders have fundamental rights guaranteed by law. These laws establish guidelines for procedures that must be followed when admitting persons into psychiatric facilities, and the rights of individuals once they have been hospitalized. These laws are very complex. Individuals of different ages have different legal status under these; therefore, it is important to pay attention to the age restrictions mentioned. To order a copy of a Pennsylvania Mental Health Law, contact

Pennsylvania Office of Mental Health & Substance Abuse Services (OMHSAS)
Room 502, PO Box 2675
Harrisburg, PA 17105-2675
Phone: 717-787-6443 Fax: 717-787-5394
www.dpw.state.pa.us/omhsas/dpwmh.asp

Pennsylvania Human Relations Commission
301 Chestnut Street, suite 300
Harrisburg, PA 17101
Phone: 717-783-9308

Some public libraries and law libraries have the United States Code and Purdons Statutes. If you want to refer to the full-text of a law, show the legal citation to a reference librarian and he or she will help you find the books you need.

I. Voluntary Hospitalization of Persons 14 Years of Age or Older with Mental Illness

Applications

Voluntary examination and treatment may be authorized by any person 14 years of age or older who feels in need of treatment and understands the nature of voluntary commitment. A notice to parents guardians, or persons standing in loco parentis of a voluntary patient between the ages of 14 and 18 will be given by telephone when possible. If that parent, guardian or person standing in loco parentis objects to the voluntary examination or treatment, he or she may file an objection in writing with the director of the facility or the administrator who shall arrange for a hearing as provided for in the Mental Health Manual. 55 Purdon Stat. Sec. 5100

Release

An individual who is 14 years of age or older must be released within 72 hours of giving notice of desire to leave unless formal commitment procedures are initiated. 50 Purdon Stat. Sec. 7206

II. Voluntary Hospitalization of Children Under 14 Years of Age

A child under the age of 14 can be placed in treatment through the voluntary action of his or her parent, guardian or other person acting in loco parentis for the child. The term "voluntary" here is not used to describe the action of a child under 14 years of age. Children and Youth Division social workers, private social workers, or foster parents, may not authorize the voluntary commitment of a child. However, a court has been held to be acting in loco parentis for a child and can voluntarily admit an individual under 14 years of age.

III. Involuntary Commitment

Application of Admission

"Involuntary commitment" means admitting someone to a hospital without his or her permission. Anyone who has legitimate interest in the person may apply for involuntary admission. To be involuntarily admitted, the person must have a mental illness which lessens his/her capacity to exercise self-control, judgment and discretion so that he/she poses a clear and present danger of harm to others or him/herself. This is legal language meaning that the person has no control over his/her actions and might hurt him/herself or someone else. 50 Purdon Stat. Sec. 7301 (a)

To be found to be a clear and present danger to others, in the last 30 days the person must have threatened harm and took action on those threats. To be a danger to him/herself, he/she must have (1) in the last 30 days the person must have shown that he/she is unable to meet his/her needs of nourishment, personal or medical care, shelter or self-protection, AND that serious harm will occur within 30 days unless the person gets treatment, OR (2) the person has attempted suicide in the last 30 days and will probably do so again without treatment, OR (3) the person must have mutilated or attempted to mutilate him/herself within the last 30 days. This means that during the last month the person did something to show that he/she can't take care of him/herself or tried to hurt or kill him/herself or someone else. 50 Purdon Stat. Sec. 7301 (B)

Emergency Applications

Emergency applications must be accompanied by a certificate from a physician stating that the proposed patient is in need of involuntary care because of a severe mental disorder. An individual may be involuntarily treated for no more than 120 hours under an emergency application for admission. If a patient is determined to need treatment beyond 120 hours, a petition for extended involuntary emergency treatment (commonly called Section 303) must be filed.

Hearings

A hearing must be held before an individual may be committed for longer than 120 hours. If the patient does not have an attorney, the court will appoint one to represent the patient at the hearing. 50 Purdon Stat. Sec. 7303

Review of the Patient's Case

All involuntary commitments are of finite duration and expire at the end of their stated term. Patients have a right to be released at the end of their term. If the treatment facility is of the opinion that a longer commitment is necessary, a new hearing must be held to obtain a new commitment. Additionally, a hospitalized patient must be examined at least once every 30 days by a treatment team to determine if continued treatment is necessary. The hospitalized individual or his or her guardian may apply to the court at any time for a release from the facility. If hospitalization is no longer medically necessary before the expiration of the patient's term of commitment, the facility must release the patient.

IV. Right to Treatment

As a patient of a mental health facility you have the right to an individualized treatment plan. The plan is to be developed within 72 hours of your admission or commitment. It must be revised as necessary and reviewed at least once every 30 days. 55 PA Code Sec. 5100.53

Right to Refuse Psychotropic Medication

If you are a voluntary patient at a state hospital, and you protest treatment with a psychotropic (mind altering) medication, your refusal is to be honored unless you pose an imminent threat of danger to yourself or others. If the medication is considered essential to your treatment and you continue to refuse, you may be transferred to another physician's care or to another facility, or may be discharged and referred to a community mental health service. You may not be denied appropriate referral on the basis of refusal to take psychotropic medication.

If you are an involuntary patient at a state hospital, are not dangerous to yourself or others, and you object to treatment with any psychotropic medication, the treatment team director must follow these procedures:

• Determine and document whether medication is necessary for treatment to prevent physical injury, and whether there are reasonable alternatives.
• Discuss with you the reasons why a specific medication is indicated and any available alternatives.
• Listen to your concerns and the reasons you object. Seek your consent.
• Document the discussions, your reasons for objecting and if your consent was obtained.
• If you still refuse the medication, obtain a second opinion from another psychiatrist based on an independent examination of you and all of your medical records or tests. If the second opinion concurs with the first, you may be administered the medication. If the second opinion does not concur with the first, a third opinion should be obtained before administering the medication.
• The risk/benefit value of the medication if given to you over your protests, the reasons for your protests, and alternative treatment approaches would be considered.
• If you continue to object to the medication, an additional opinion based on independent review should be obtained every 30 days as to the continuing need for medication.
• You and those helping you should be given the opportunity to discuss your concerns and objections to the medication at all treatment team planning and review sessions. Your objections should be documented in your treatment plan. (From the Pennsylvania Office Mental Health: Mental Health Bulletin, Number 99-85-10.)

Discharge Summary and Aftercare

The national standards for discharge summaries, listed in the Medicare Regulations applicable to psychiatric hospitals, provide that the record of each discharged patient must have a "Discharge Summary" that includes a review of "the patient's hospitalization and recommendations from appropriate services concerning follow-up or aftercare as well as a brief summary of the patient's condition on discharge." 51 Federal Register 116 (Sec. 482.61)

The Consolidated Standards Manual, 1987, of the Joint Commission of Accreditation of Healthcare Organizations states that the discharge summary must be entered within 15 days following discharge. The discharge summary includes the results of the initial assessment and diagnosis and a clinical resume that summarizes the following:

• the significant findings
• the course and progress of the patient with regard to each identified clinical problem
• the clinical course of the patient's treatment
• the final assessment including the general observations and understanding of the patient's condition initially, during treatment, and at discharge
• the recommendations and arrangements for further treatment including prescribed medications and aftercare

The written Aftercare Plan for continuing treatment, when appropriate, describes the facilities responsibility for the patient's transfer to another program, another agency, another individual, and/or the patient's support system.

The patient, and when indicated, the family, guardian, or significant other should participate in the development of the Aftercare Plan. Whenever possible, the Aftercare Plan should be implemented in a manner acceptable to the patient's need for confidentiality. Consolidated Standards Manual, 1987 (page 82)

Financial Responsibility for Care and Treatment

According to Pennsylvania law, if the patient is a minor the parent or other person with a legal duty to support the patient is responsible for treatment expenses at state mental health facilities. 50 Purdon Stat. Sec. 4501 and 4501

The extent of a person's liability to pay is based on his/her ability to pay. The applicable regulations are 55 PA Code Chapter 4305 (for Community MH/MR Centers) and 55 PA Code Chapter 4310 (for state-operated MH/MR facilities.)

For more information, contact your local County Office of Mental Health and/or your Regional Office of Mental Health.

Field Office and Statewide CASSP Contacts:

Statewide CASSP Contact
Harrisburg State Hospital
Sherry Peters
717-772-7855
717-772-7827 (fax)
SPeters@dpw.state.pa.us

Pittsburgh Field Office CASSP Contact
State Office Building
Elaine Bobick
412-565-5432
412-565-5393 (fax)

Harrisburg Field Office CASSP Contact
Harrisburg State Hospital
Barbara Johncour
717-772-6835
717-772-6650 (fax)
BarbaraJ@dpw.state.pa.us

Scranton Field Office CASSP Contact
Mike Orr
State Office Building
570-963-4943
570-963-3050 (fax)
MikeO@dpw.state.pa.us

Philadelphia Field Office CASSP Contact
Richard Gladstone
Norristown State Hospital
EBobick@dpw.state.pa.us
610-313-5731
610-313-5845 (fax)
RGladstone@dpw.state.pa.us

Statewide Resources: When You Run Into Problems Concerning Your Rights or Your Child's Rights

Disabilities Law Project
1315 Walnut Street, Suite 400
Philadelphia, PA 19107
215-238-8070
and
1708 Law and Finance building
429 Fourth Avenue
Pittsburgh, PA 15219
412-391-5225
Provides free legal assistance to children and adults who are developmentally disabled, including children with serious mental health problems, in cases involving discrimination on the basis of handicap or access to services.

Parents Involved Network
1211 Chestnut Street, 11th Floor
Philadelphia, PA 19107
215-751-1800, 1-800-688-4226, www.pinofpa.org
A statewide, self-help/advocacy, information and referral resource for parents of children and adolescents who have emotional or behavioral disorders.

Pennsylvania Protection and Advocacy - Children's Project
1315 Walnut Street, Suite 400
Philadelphia, PA 19107
800-583-6007 or e-mail: ppakids@elc-pa.org
A statewide advocacy organization which provides inform

Parents Involved Network - ©1999-2004