Patient Rights in Texas

Patient Rights in Texas

Know Know Your Your

Rights Rights

Health Law Council of the State Bar of Texas Health Law Council of the State Bar of Texas

Patient Rights in Texas

Patient Rights in Texas

Know Know Your Your

Rights Rights

Health Law Council of the State Bar of Texas Health Law Council of the State Bar of Texas

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AcknowledgementsAcknowledgements This Know Your Rights brochure was developed by the Know Your Rights Committee (“Committee”) of the Health Law Council of the State Bar of Texas. The intent of this brochure is to provide a general over-view of certain areas of health care to assist the consumer in making in-formed decisions. The law changes frequently and is subject to various interpretations by different courts. Future changes in the law may make some information in this brochure inaccurate. This brochure is not in-tended to and does not replace an attorney's advice or assistance. The Committee gratefully acknowledges the contributions of the follow-ing firms and individuals for their contributions to this brochure: Topic Submissions: • Ken Gordon, Baker & McKenzie LLP • Wilson Jones, Baker & McKenzie LLP • David Hilgers, Brown McCarroll, L.L.P. • Deborah Hiser, Brown McCarroll, L.L.P. • Bruce Howell, Hughes & Luce, LLP • Jennifer Graul, Hughes & Luce, LLP • Yvonne Puig, Fulbright & Jaworski, L.L.P. • Tom Mayo, SMU/Dedman School of Law, Haynes and Boone, LLP • Kristen Bell, SMU/Dedman School of Law • Elizabeth Rogers, Vinson & Elkins, LLP • Leah Stewart, Vinson & Elkins, LLP Brochure Editing and Layout: • Rosemaria Levinsky, Hendrick Health System • Tim FitzGerald, Hendrick Health System Know Your Rights Committee: • Rosemaria Levinsky, Hendrick Health System (Chair) • David Briggs, Briggs & Associates • Fred Bockstahler, Driscoll Children’s Hospital • Lisa Frenkel, HCA Inc. • Bruce Howell, Hughes & Luce, LLP • Max Maxwell, Max Maxwell Law Practice • Yvonne Puig, Fulbright & Jaworski, L.L.P. • Michael Regier, Seton Healthcare Network • Matt Wall, Texas Hospital Association 2

AcknowledgementsAcknowledgements This Know Your Rights brochure was developed by the Know Your Rights Committee (“Committee”) of the Health Law Council of the State Bar of Texas. The intent of this brochure is to provide a general over-view of certain areas of health care to assist the consumer in making in-formed decisions. The law changes frequently and is subject to various interpretations by different courts. Future changes in the law may make some information in this brochure inaccurate. This brochure is not in-tended to and does not replace an attorney's advice or assistance. The Committee gratefully acknowledges the contributions of the follow-ing firms and individuals for their contributions to this brochure: Topic Submissions: • Ken Gordon, Baker & McKenzie LLP • Wilson Jones, Baker & McKenzie LLP • David Hilgers, Brown McCarroll, L.L.P. • Deborah Hiser, Brown McCarroll, L.L.P. • Bruce Howell, Hughes & Luce, LLP • Jennifer Graul, Hughes & Luce, LLP • Yvonne Puig, Fulbright & Jaworski, L.L.P. • Tom Mayo, SMU/Dedman School of Law, Haynes and Boone, LLP • Kristen Bell, SMU/Dedman School of Law • Elizabeth Rogers, Vinson & Elkins, LLP • Leah Stewart, Vinson & Elkins, LLP Brochure Editing and Layout: • Rosemaria Levinsky, Hendrick Health System • Tim FitzGerald, Hendrick Health System Know Your Rights Committee: • Rosemaria Levinsky, Hendrick Health System (Chair) • David Briggs, Briggs & Associates • Fred Bockstahler, Driscoll Children’s Hospital • Lisa Frenkel, HCA Inc. • Bruce Howell, Hughes & Luce, LLP • Max Maxwell, Max Maxwell Law Practice • Yvonne Puig, Fulbright & Jaworski, L.L.P. • Michael Regier, Seton Healthcare Network • Matt Wall, Texas Hospital Association

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What you need to know about . . . Confidentiality of Health Care Records and Information ............4 Advance Directives ......................................................................6 Declaration for Mental Health Treatment ....................................8 Health Care Decision-Making......................................................9 Your Access to Health Care .......................................................10 Reporting Requirements.............................................................12 Charity Care................................................................................14 Your Rights While Receiving Voluntary Inpatient Mental Health Services...........................................................................15 Your Rights While Receiving Involuntary Inpatient Mental Health Services...........................................................................16 Your Right to Refuse Psychotropic Medication.........................20

Table of ContentsTable of Contents

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What you need to know about . . . Confidentiality of Health Care Records and Information ............4 Advance Directives ......................................................................6 Declaration for Mental Health Treatment ....................................8 Health Care Decision-Making......................................................9 Your Access to Health Care .......................................................10 Reporting Requirements.............................................................12 Charity Care................................................................................14 Your Rights While Receiving Voluntary Inpatient Mental Health Services...........................................................................15 Your Rights While Receiving Involuntary Inpatient Mental Health Services...........................................................................16 Your Right to Refuse Psychotropic Medication.........................20

Table of ContentsTable of Contents

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This section deals with the privacy of your medical records and other sensi-tive health care information. What this means to you . . . With the increasing use of computers and electronic files to store health care information, you have more reason than ever to care about the privacy

of your medical records. Both federal and Texas laws provide you with some privacy protections.

It is important for you to know your rights so that you can protect your

sensitive health care information.

Notice. Whenever you seek medi-cal treatment or apply for health care

benefits, the health care provider or health plan must give you a “Notice of Privacy

Practices.” This notice must explain how they intend to use and disclose your health

care information and when your authorization is required. The notice must also state your privacy rights and tell you how to file a complaint if you think these rights have been violated. While health care providers are re-quired to make a “good faith effort” to obtain your signature acknowledging that you received this notice, your signature is not required. Always read these notices carefully. If you do not understand something in the notice, ask questions. You can also ask for a copy at any time. Special Requests. You have the right to request a restriction on the use or disclosure of your health care information. However, be aware that health care providers are not obligated to agree to a requested restriction. You also have the right to reasonably request confidential communications. For ex-ample, you might prefer that telephone calls regarding your treatment be made to your home rather than office. Access. You have the right to see, copy, and request changes to your own medical records. You should know that a hospital or physician may charge you a reasonable fee for providing the requested records.

What you need to know

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What you need to know

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Confidentiality of Health CareConfidentiality of Health Care Records and Information Records and Information

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This section deals with the privacy of your medical records and other sensi-tive health care information. What this means to you . . . With the increasing use of computers and electronic files to store health care information, you have more reason than ever to care about the privacy

of your medical records. Both federal and Texas laws provide you with some privacy protections.

It is important for you to know your rights so that you can protect your

sensitive health care information.

Notice. Whenever you seek medi-cal treatment or apply for health care

benefits, the health care provider or health plan must give you a “Notice of Privacy

Practices.” This notice must explain how they intend to use and disclose your health

care information and when your authorization is required. The notice must also state your privacy rights and tell you how to file a complaint if you think these rights have been violated. While health care providers are re-quired to make a “good faith effort” to obtain your signature acknowledging that you received this notice, your signature is not required. Always read these notices carefully. If you do not understand something in the notice, ask questions. You can also ask for a copy at any time. Special Requests. You have the right to request a restriction on the use or disclosure of your health care information. However, be aware that health care providers are not obligated to agree to a requested restriction. You also have the right to reasonably request confidential communications. For ex-ample, you might prefer that telephone calls regarding your treatment be made to your home rather than office. Access. You have the right to see, copy, and request changes to your own medical records. You should know that a hospital or physician may charge you a reasonable fee for providing the requested records.

What you need to know

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What you need to know

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Confidentiality of Health CareConfidentiality of Health Care Records and Information Records and Information

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Additional Protections. Both federal and Texas laws provide additional protections for sensitive types of health care information, such as substance abuse records, AIDS test results, genetic information, and mental health and mental retardation records. Report of Disclosures. Your health information may be used and shared without your written authorization for particular reasons, like making sure your health care providers have access to this information to assist them in providing you care. You can ask for and get a list of those with whom your health information has been shared. You can get this report once a year for free. Corrections. You can ask to change any wrong information in your medi-cal record or add information to your medical record if it is incomplete. For example, if you and your hospital agree that your medical record has the wrong result for a test, the hospital will make note in your medical record of the corrected information. Even if the hospital believes the test result is cor-rect, you still have the right to have your disagreement noted in your medi-cal record. Violations of Your Rights. Federal law requires all health care providers and health plans to appoint a Privacy Officer. If you believe that your pri-vacy rights have been violated, you may want to first contact this individual in your effort to resolve a privacy issue. You may also file a written com-plaint with the HHS Office for Civil Rights, by visiting the website listed below, within 180 days of an incident. Other Resources: • HHS Office for Civil Rights (http://www.hhs.gov/ocr/hipaa) • Health Privacy Project (http://www.healthprivacy.org) • Texas Department of Insurance (http://www.tdi.state.tx.us) • Office of the Texas Attorney General (http://www.oag.state.tx.us) • Texas State Board of Medical Examiners (http://www.tsbme.state.tx.us) • Texas Department of State Health Services (http://www.tdh.state.tx.us)

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Additional Protections. Both federal and Texas laws provide additional protections for sensitive types of health care information, such as substance abuse records, AIDS test results, genetic information, and mental health and mental retardation records. Report of Disclosures. Your health information may be used and shared without your written authorization for particular reasons, like making sure your health care providers have access to this information to assist them in providing you care. You can ask for and get a list of those with whom your health information has been shared. You can get this report once a year for free. Corrections. You can ask to change any wrong information in your medi-cal record or add information to your medical record if it is incomplete. For example, if you and your hospital agree that your medical record has the wrong result for a test, the hospital will make note in your medical record of the corrected information. Even if the hospital believes the test result is cor-rect, you still have the right to have your disagreement noted in your medi-cal record. Violations of Your Rights. Federal law requires all health care providers and health plans to appoint a Privacy Officer. If you believe that your pri-vacy rights have been violated, you may want to first contact this individual in your effort to resolve a privacy issue. You may also file a written com-plaint with the HHS Office for Civil Rights, by visiting the website listed below, within 180 days of an incident. Other Resources: • HHS Office for Civil Rights (http://www.hhs.gov/ocr/hipaa) • Health Privacy Project (http://www.healthprivacy.org) • Texas Department of Insurance (http://www.tdi.state.tx.us) • Office of the Texas Attorney General (http://www.oag.state.tx.us) • Texas State Board of Medical Examiners (http://www.tsbme.state.tx.us) • Texas Department of State Health Services (http://www.tdh.state.tx.us)

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When you need medical care, you have the right to make informed de-cisions about the care you will receive and communicate these deci-sions to your physician. However, if you become unable to tell your physician or family what kind of medical care you want, the decisions regarding your care become much more difficult. An advance directive is a legal document that allows you to tell your physician and family your preferences for medical treatment before you actually need care. An advance directive can relieve your family of the burden of making serious medical decisions without your input and pro-vides your physician clear guidelines for your care. Three types of ad-vance directives in Texas are a Directive to Physicians, a Medical Power of Attorney, and an Out-of-Hospital Do-Not-Resuscitate Or-der. A Directive to Physicians, sometimes called a “living will,” allows you to make medical decisions ahead of time so your physician can know your wishes for treatment if you are in a terminal or irreversible condition and become unable to communicate or make informed deci-sions. Under Texas law, a “terminal condition” means an incurable condition that a physician believes will result in death within six months. An “irreversible condition” is a condition, injury, or illness that is never cured or eliminated, leaves you unable to care for yourself, and will be fatal without life-sustaining treatment. Through a Directive to Physicians, you can give your physician instructions regarding your wishes for care and treatment, including the withholding or withdrawal of life-sustaining treatment such as mechanical breathing machines, tube feeding, IVs, or CPR. You can also tell your physician that you want to be kept pain free. A Medical Power of Attorney allows you to designate someone you trust to make health care decisions on your behalf in case you become unable to do so yourself. The person you designate as your agent under a Medical Power of Attorney may make health care decisions for you, whether or not you have a terminal or irreversible condition. Your agent’s authority begins when your physician certifies that you are not competent to make health care decisions yourself. Unless you state oth-erwise, your agent generally has the same authority to make health care decisions for you as you did before you became incapacitated. How-ever, your agent must honor your Directive to Physicians and your

What you need to know

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What you need to know

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ADVANCE DIRECTIVES ADVANCE DIRECTIVES

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When you need medical care, you have the right to make informed de-cisions about the care you will receive and communicate these deci-sions to your physician. However, if you become unable to tell your physician or family what kind of medical care you want, the decisions regarding your care become much more difficult. An advance directive is a legal document that allows you to tell your physician and family your preferences for medical treatment before you actually need care. An advance directive can relieve your family of the burden of making serious medical decisions without your input and pro-vides your physician clear guidelines for your care. Three types of ad-vance directives in Texas are a Directive to Physicians, a Medical Power of Attorney, and an Out-of-Hospital Do-Not-Resuscitate Or-der. A Directive to Physicians, sometimes called a “living will,” allows you to make medical decisions ahead of time so your physician can know your wishes for treatment if you are in a terminal or irreversible condition and become unable to communicate or make informed deci-sions. Under Texas law, a “terminal condition” means an incurable condition that a physician believes will result in death within six months. An “irreversible condition” is a condition, injury, or illness that is never cured or eliminated, leaves you unable to care for yourself, and will be fatal without life-sustaining treatment. Through a Directive to Physicians, you can give your physician instructions regarding your wishes for care and treatment, including the withholding or withdrawal of life-sustaining treatment such as mechanical breathing machines, tube feeding, IVs, or CPR. You can also tell your physician that you want to be kept pain free. A Medical Power of Attorney allows you to designate someone you trust to make health care decisions on your behalf in case you become unable to do so yourself. The person you designate as your agent under a Medical Power of Attorney may make health care decisions for you, whether or not you have a terminal or irreversible condition. Your agent’s authority begins when your physician certifies that you are not competent to make health care decisions yourself. Unless you state oth-erwise, your agent generally has the same authority to make health care decisions for you as you did before you became incapacitated. How-ever, your agent must honor your Directive to Physicians and your

What you need to know

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What you need to know

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ADVANCE DIRECTIVES ADVANCE DIRECTIVES

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agent may not consent to voluntary inpatient mental health services, convulsive treatment, psychosurgery, abortion, or withholding treat-ment intended for comfort. The Medical Power of Attorney applies only to health care decisions—not to decisions regarding your financial matters. An Out-of-Hospital Do-Not-Resuscitate (DNR) Order is a form you complete with your physician that allows you to refuse specific life-sustaining treatment outside of a hospital. You can instruct emergency personnel not to attempt CPR, artificial ventilation, or defibrillation. To alert a health care provider that you have an Out-of-Hospital DNR Or-der, you must have a copy of the form with you or wear an approved “DNR identification device,” such as a necklace or bracelet. You can obtain a DNR ID necklace or bracelet from your physician. All three forms discussed above must be signed in the presence of two adult witnesses, who are not related to you and do not have an interest in your estate. The Out-of-Hospital DNR Order must also be signed by your physician. You may revoke a Directive to Physicians, a Medical Power of Attorney, or an Out-of-Hospital DNR Order at any time. Even after you have signed one of these documents, you still have the right to make medical decisions for yourself as long as your physician deems that you are capable of making informed decisions. If you become unable to communicate or make informed decisions and you do not have a Directive to Physicians or a Medical Power of Attor-ney, your physician and your guardian or other available family member may make a treatment decision for you that includes the withholding or withdrawing of life-sustaining treatment. The Texas Ad-vance Directives Act lists the priority of family members that may be consulted for a treatment decision, beginning with your spouse. If you do not have a legal guardian or reasonably available relative, your physician must have another physi-cian concur with his or her treatment deci-sion. If you have questions regarding advance directives or if you would like to create one for yourself, please contact your lawyer, your physician, or the near-est hospital.

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agent may not consent to voluntary inpatient mental health services, convulsive treatment, psychosurgery, abortion, or withholding treat-ment intended for comfort. The Medical Power of Attorney applies only to health care decisions—not to decisions regarding your financial matters. An Out-of-Hospital Do-Not-Resuscitate (DNR) Order is a form you complete with your physician that allows you to refuse specific life-sustaining treatment outside of a hospital. You can instruct emergency personnel not to attempt CPR, artificial ventilation, or defibrillation. To alert a health care provider that you have an Out-of-Hospital DNR Or-der, you must have a copy of the form with you or wear an approved “DNR identification device,” such as a necklace or bracelet. You can obtain a DNR ID necklace or bracelet from your physician. All three forms discussed above must be signed in the presence of two adult witnesses, who are not related to you and do not have an interest in your estate. The Out-of-Hospital DNR Order must also be signed by your physician. You may revoke a Directive to Physicians, a Medical Power of Attorney, or an Out-of-Hospital DNR Order at any time. Even after you have signed one of these documents, you still have the right to make medical decisions for yourself as long as your physician deems that you are capable of making informed decisions. If you become unable to communicate or make informed decisions and you do not have a Directive to Physicians or a Medical Power of Attor-ney, your physician and your guardian or other available family member may make a treatment decision for you that includes the withholding or withdrawing of life-sustaining treatment. The Texas Ad-vance Directives Act lists the priority of family members that may be consulted for a treatment decision, beginning with your spouse. If you do not have a legal guardian or reasonably available relative, your physician must have another physi-cian concur with his or her treatment deci-sion. If you have questions regarding advance directives or if you would like to create one for yourself, please contact your lawyer, your physician, or the near-est hospital.

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What you need to know

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What you need to know

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Texas law allows you to make a Declaration for Mental Health Treatment (commonly called a "Psychiatric Advance Directive"), to control your men-tal health treatment in the event that you become unable, due to illness, to make treatment decisions. A Psychiatric Advance Directive allows you to make decisions in advance, while you have the mental and physical capac-ity, about three kinds of treatment: (1) psychotropic medications; (2) elec-troconvulsive treatment (ECT); and (3) intervention to be used during an emergency to calm you down. Once a Psychiatric Advance Directive is created and signed, it is difficult to change or cancel. If you decide to make a Psychiatric Advance Directive, you should discuss this decision with a physician, a lawyer, family, and friends whom you trust to help you make good decisions. Your Psychiatric Advance Directive will be used when you are found inca-pable of making mental health treatment decisions by a judge in a guardian-ship or a medication proceeding. To make a Psychiatric Advance Directive, you must be legally competent, meaning that a judge has not found that you can no longer make medical decisions. (To be enforceable, the Psychiatric Advance Directive must be signed and dated by you and two adult witnesses.) You should take a copy of the executed Psychiatric Advance Directive with you when you enter a hospital or other facility. Your Psychiatric Advance Directive is valid for three years from the date you and your witnesses sign it unless: (i) it is extended because you are found to be incapable of making mental health treatment decisions at the end of the three years; (ii) you cancel it; or, (iii) you execute a new Psychi-atric Advance Directive. If you are found by a court to be incapable of making mental health treat-ment decisions at the end of three years, your Psychiatric Advance Direc-tive will continue to be used for as long as you are found incapable. If you wish to retain some control over your mental health treatment in the event that you become incapacitated, executing a Psychiatric Advance Di-rective will allow you to determine the type of treatment you will be given. If you have questions, contact Advocacy, Incorporated at 1-800-252-9108 or Texas Mental Health Commission at 1-800-860-6057.

DECLARATION FORDECLARATION FOR MENTAL HEALTH TREATMENTMENTAL HEALTH TREATMENT

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What you need to know

about . . .

What you need to know

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Texas law allows you to make a Declaration for Mental Health Treatment (commonly called a "Psychiatric Advance Directive"), to control your men-tal health treatment in the event that you become unable, due to illness, to make treatment decisions. A Psychiatric Advance Directive allows you to make decisions in advance, while you have the mental and physical capac-ity, about three kinds of treatment: (1) psychotropic medications; (2) elec-troconvulsive treatment (ECT); and (3) intervention to be used during an emergency to calm you down. Once a Psychiatric Advance Directive is created and signed, it is difficult to change or cancel. If you decide to make a Psychiatric Advance Directive, you should discuss this decision with a physician, a lawyer, family, and friends whom you trust to help you make good decisions. Your Psychiatric Advance Directive will be used when you are found inca-pable of making mental health treatment decisions by a judge in a guardian-ship or a medication proceeding. To make a Psychiatric Advance Directive, you must be legally competent, meaning that a judge has not found that you can no longer make medical decisions. (To be enforceable, the Psychiatric Advance Directive must be signed and dated by you and two adult witnesses.) You should take a copy of the executed Psychiatric Advance Directive with you when you enter a hospital or other facility. Your Psychiatric Advance Directive is valid for three years from the date you and your witnesses sign it unless: (i) it is extended because you are found to be incapable of making mental health treatment decisions at the end of the three years; (ii) you cancel it; or, (iii) you execute a new Psychi-atric Advance Directive. If you are found by a court to be incapable of making mental health treat-ment decisions at the end of three years, your Psychiatric Advance Direc-tive will continue to be used for as long as you are found incapable. If you wish to retain some control over your mental health treatment in the event that you become incapacitated, executing a Psychiatric Advance Di-rective will allow you to determine the type of treatment you will be given. If you have questions, contact Advocacy, Incorporated at 1-800-252-9108 or Texas Mental Health Commission at 1-800-860-6057.

DECLARATION FORDECLARATION FOR MENTAL HEALTH TREATMENTMENTAL HEALTH TREATMENT

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What you need to know

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What you need to know

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Physicians and other health care providers have a duty to obtain your agreement before they may provide you with medical treatment or per-form a surgical procedure on you. The decision-making process by which you agree to have health care providers provide you with medical treatment, including surgical procedures, is often referred to as “informed consent.”

Generally speaking, children under the age of 18 do not have the capac-ity to consent to their own medical treatment. Therefore, health care providers must obtain informed consent from a person authorized to con-sent for the child. In most cases, this person will be one of the child’s parents.

Sometimes, e.g., when emergency treatment is required for yourself or your child, informed consent may be implied from the circumstances.

What this means to you . . .

You should expect that the physician who will provide the medical treat-ment will explain the following to you in a way you can understand:

• The treatment to be provided;

• Additional treatments that may need to be pro-vided at the same time;

• The risks associated with the treatment;

• Benefits derived from the treatment;

• Alternatives to the treatment; and

• Consequences of not undergo-ing the treatment.

In addition, you should ask the phy-sician questions if there is something you do not understand or want to know about the medical treat-ment. You may be asked to sign a consent form.

HEALTH CARE DECISIONHEALTH CARE DECISION--MAKINGMAKING

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What you need to know

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What you need to know

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Physicians and other health care providers have a duty to obtain your agreement before they may provide you with medical treatment or per-form a surgical procedure on you. The decision-making process by which you agree to have health care providers provide you with medical treatment, including surgical procedures, is often referred to as “informed consent.”

Generally speaking, children under the age of 18 do not have the capac-ity to consent to their own medical treatment. Therefore, health care providers must obtain informed consent from a person authorized to con-sent for the child. In most cases, this person will be one of the child’s parents.

Sometimes, e.g., when emergency treatment is required for yourself or your child, informed consent may be implied from the circumstances.

What this means to you . . .

You should expect that the physician who will provide the medical treat-ment will explain the following to you in a way you can understand:

• The treatment to be provided;

• Additional treatments that may need to be pro-vided at the same time;

• The risks associated with the treatment;

• Benefits derived from the treatment;

• Alternatives to the treatment; and

• Consequences of not undergo-ing the treatment.

In addition, you should ask the phy-sician questions if there is something you do not understand or want to know about the medical treat-ment. You may be asked to sign a consent form.

HEALTH CARE DECISIONHEALTH CARE DECISION--MAKINGMAKING

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In the state of Texas, those who are not privately insured have several avenues to receive medical care. Emergency Care. Under Texas law, a hospital may not deny emergency services because the hospital cannot establish a patient’s ability to pay for the services or because of the patient’s race, religion or na-tional ancestry. Emergency care is defined as care that must be provided immediately to sustain life, prevent serious perma-nent disfigurement or impairment, or provide for the care of a woman in active labor. If the hospital cannot pro-vide this care, the hospital may make arrangements to transfer a patient to another hospital that can provide for emergency needs but cannot transfer the patient to another hospital based on the patient’s inability to pay for emergency services. It is important to remember that this right to receive emergency care does not mean that the hospital cannot bill for the care provided, and arrangements will need to be made with the hospital if the patient cannot pay for the care provided. Charity Care. Although there is no individual right to charity care, non-profit hospitals are required by Texas law to provide a certain amount of charity care each year. If a hospital provides charity care, this information will be posted in the emergency room, general waiting areas, and other visible locations. You may submit an application at any time to receive charity care from a non-profit hospital, even after you have re-ceived treatment. It is within the hospital’s discretion when and to what extent charity care will be provided. (Also, please refer to the Charity Care section in this brochure.) County Public Hospitals. Some basic health care needs can be met by county public hospitals or mandated providers that have agreed to meet the basic health care needs of the county’s residents. Basic health care may include immunizations, a yearly physical, medical screenings, some prescription drugs, family planning services, inpatient/outpatient ser-vices, and other care determined by the county. To apply for these ser-vices, you must submit an application to the county and comply with the requirements of the county program.

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What you need to know

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YOUR ACCCESS TO HEALTH CARE YOUR ACCCESS TO HEALTH CARE

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In the state of Texas, those who are not privately insured have several avenues to receive medical care. Emergency Care. Under Texas law, a hospital may not deny emergency services because the hospital cannot establish a patient’s ability to pay for the services or because of the patient’s race, religion or na-tional ancestry. Emergency care is defined as care that must be provided immediately to sustain life, prevent serious perma-nent disfigurement or impairment, or provide for the care of a woman in active labor. If the hospital cannot pro-vide this care, the hospital may make arrangements to transfer a patient to another hospital that can provide for emergency needs but cannot transfer the patient to another hospital based on the patient’s inability to pay for emergency services. It is important to remember that this right to receive emergency care does not mean that the hospital cannot bill for the care provided, and arrangements will need to be made with the hospital if the patient cannot pay for the care provided. Charity Care. Although there is no individual right to charity care, non-profit hospitals are required by Texas law to provide a certain amount of charity care each year. If a hospital provides charity care, this information will be posted in the emergency room, general waiting areas, and other visible locations. You may submit an application at any time to receive charity care from a non-profit hospital, even after you have re-ceived treatment. It is within the hospital’s discretion when and to what extent charity care will be provided. (Also, please refer to the Charity Care section in this brochure.) County Public Hospitals. Some basic health care needs can be met by county public hospitals or mandated providers that have agreed to meet the basic health care needs of the county’s residents. Basic health care may include immunizations, a yearly physical, medical screenings, some prescription drugs, family planning services, inpatient/outpatient ser-vices, and other care determined by the county. To apply for these ser-vices, you must submit an application to the county and comply with the requirements of the county program.

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What you need to know

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YOUR ACCCESS TO HEALTH CARE YOUR ACCCESS TO HEALTH CARE

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State and Federal Government Programs. Several state and federal programs also provide funding for health care. These programs in-clude Medicaid, Temporary Assistance for Families (TANF), and the Children’s Health Insurance Program (CHIP). What this means to you . . . As a resident of the state of Texas, there are several ways that you can receive health care services. It is important that you plan ahead for needed health care by submitting the proper applications to be eligible for state, federal or county funds and knowing which hospitals in your area provide charity care. In the event that you feel you have been denied emergency medical treatment based on your inability to pay or have been discriminated against based on your race, religion or national ancestry in receiving this care, contact the Texas or U.S. Office of Civil Rights to deter-mine if your rights have been violated. For further information about access to care . . . Office of Civil Rights Texas Health and Human Services Commission Texas Department of State Health Services 1100 West 49th Street, G-112 Austin, Texas 78756 (512) 458-7627 http://www.hhs.state.tx.us/aboutHHS/CivilRights.shtml Office for Civil Rights U.S. Department of Health and Human Services 200 Independence Ave., SW H.H.H. Building, Room 509-F Washington, D.C. 20201 (202) 619-0403 Texas Department of Health and Human Services Medicaid Hotline (800) 252-8263 http://www.hhsc.state.tx.us

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State and Federal Government Programs. Several state and federal programs also provide funding for health care. These programs in-clude Medicaid, Temporary Assistance for Families (TANF), and the Children’s Health Insurance Program (CHIP). What this means to you . . . As a resident of the state of Texas, there are several ways that you can receive health care services. It is important that you plan ahead for needed health care by submitting the proper applications to be eligible for state, federal or county funds and knowing which hospitals in your area provide charity care. In the event that you feel you have been denied emergency medical treatment based on your inability to pay or have been discriminated against based on your race, religion or national ancestry in receiving this care, contact the Texas or U.S. Office of Civil Rights to deter-mine if your rights have been violated. For further information about access to care . . . Office of Civil Rights Texas Health and Human Services Commission Texas Department of State Health Services 1100 West 49th Street, G-112 Austin, Texas 78756 (512) 458-7627 http://www.hhs.state.tx.us/aboutHHS/CivilRights.shtml Office for Civil Rights U.S. Department of Health and Human Services 200 Independence Ave., SW H.H.H. Building, Room 509-F Washington, D.C. 20201 (202) 619-0403 Texas Department of Health and Human Services Medicaid Hotline (800) 252-8263 http://www.hhsc.state.tx.us

12

What you need to know

about . . .

What you need to know

about . . .

REPORTING REQUIREMENTS REPORTING REQUIREMENTS

State governments are charged with protecting public health and safety. Therefore, Texas legislators have passed numerous laws requiring health care providers to

report certain medical incidents and diseases to various state agencies. For example, health care providers are re-

quired to report certain communicable diseases, birth defects, cancers, and traumatic injuries. To iden-tify possible abusers and criminals, providers are required to report gunshot wounds to local au-

thorities, and suspected cases of child, adult and elder abuse to protective agencies. Parties that are re-

quired to report these conditions include health care pro-viders; hospital, nursing home and laboratory administra-

tors; and sometimes even guardians of children with re-portable conditions.

When a health care provider makes a report under any of these mandatory reporting requirements, the provider is required to report detailed informa-tion about you to the state or local authority, including your name and other identifiable information. If you or someone in your care has a reportable condition, talk to your health care provider about his/her intentions to report this condition to the proper state agency. Because of strict privacy standards imposed on the government under the federal Health Insurance Portability and Accountability Act (HIPAA), this information should only be used for the limited purposes that further the state’s objective. In the event you feel your protected health information has been disclosed in an inappropriate manner, contact the Office of Civil Rights for the US Department of Health and Human Services or visit their website for more information. For further information on reporting requirements . . . Texas Department of State Health Services Infectious Disease Epidemiology & Surveillance Division (800) 705-8868 http://www.tdh.state.tx.us/ideas/report/conditions

12

What you need to know

about . . .

What you need to know

about . . .

REPORTING REQUIREMENTS REPORTING REQUIREMENTS

State governments are charged with protecting public health and safety. Therefore, Texas legislators have passed numerous laws requiring health care providers to

report certain medical incidents and diseases to various state agencies. For example, health care providers are re-

quired to report certain communicable diseases, birth defects, cancers, and traumatic injuries. To iden-tify possible abusers and criminals, providers are required to report gunshot wounds to local au-

thorities, and suspected cases of child, adult and elder abuse to protective agencies. Parties that are re-

quired to report these conditions include health care pro-viders; hospital, nursing home and laboratory administra-

tors; and sometimes even guardians of children with re-portable conditions.

When a health care provider makes a report under any of these mandatory reporting requirements, the provider is required to report detailed informa-tion about you to the state or local authority, including your name and other identifiable information. If you or someone in your care has a reportable condition, talk to your health care provider about his/her intentions to report this condition to the proper state agency. Because of strict privacy standards imposed on the government under the federal Health Insurance Portability and Accountability Act (HIPAA), this information should only be used for the limited purposes that further the state’s objective. In the event you feel your protected health information has been disclosed in an inappropriate manner, contact the Office of Civil Rights for the US Department of Health and Human Services or visit their website for more information. For further information on reporting requirements . . . Texas Department of State Health Services Infectious Disease Epidemiology & Surveillance Division (800) 705-8868 http://www.tdh.state.tx.us/ideas/report/conditions

13

Texas Department of State Health Services Texas Birth Defects Monitoring Division (512) 458-7232 http://www.tdh.state.tx.us/tbdmd/index.htm Texas Department of State Health Services Texas Cancer Registry (800) 252-8059 http://www.tdh.state.tx.us/tcr/reporting.html Texas Department of State Health Services Injury Epidemiology Surveillance and EMS/Trauma Registry Team (800) 735-2989 http://www.tdh.state.tx.us/injury/ Texas Department of Aging and Disability (800) 458-9858 http://www.dads.state.tx.us/news_info/report_problems.html#fraud Texas Department of Family and Protective Services (800) 252-5400 http://www.txabusehotline.org/PublicMain.asp

13

Texas Department of State Health Services Texas Birth Defects Monitoring Division (512) 458-7232 http://www.tdh.state.tx.us/tbdmd/index.htm Texas Department of State Health Services Texas Cancer Registry (800) 252-8059 http://www.tdh.state.tx.us/tcr/reporting.html Texas Department of State Health Services Injury Epidemiology Surveillance and EMS/Trauma Registry Team (800) 735-2989 http://www.tdh.state.tx.us/injury/ Texas Department of Aging and Disability (800) 458-9858 http://www.dads.state.tx.us/news_info/report_problems.html#fraud Texas Department of Family and Protective Services (800) 252-5400 http://www.txabusehotline.org/PublicMain.asp

14

Charity care is defined as free or reduced cost health care provided to those who have no health insurance or who cannot afford to pay for health care. In Texas, each public and non-profit hospital is required to provide a cer-tain amount of charity care. In addition, for-profit hospitals, although not required under Texas law to provide charity care, often have charity care or financial assistance programs. Finally, regardless of the type of hospital, every hospital with an emergency room must treat people who are diag-nosed by licensed physicians as requiring emergency services, regardless of their ability to pay. What this means to you . . . You may be eligible for free or reduced cost health care at certain hospitals in your community. Although anyone can apply for charity care, hospitals have a right to ask financial questions to determine a patient’s eligibility. Patients wishing to apply for charity care must provide all requested finan-cial information to the hospital. Each hospital will establish its own eligi-bility criteria, within certain legal guidelines, but are always based on a patient’s ability to pay. It is important to remember that charity care programs are not a substitute for health insurance or for any government health assistance programs. Hospitals will usually accept insurance first (including Medicare or Medi-caid) and provide charity care only if you have no insurance and cannot afford to pay. Most public and non-profit hospitals provide notice of their charity care programs and how to apply. If you are unsure whether a hospital offers charity care, ask an admissions clerk or billing department representative.

Resources . . . If you think you may qualify for a charity care program, ask the hospital for its policies and application process. To file a complaint or ask questions about a particular hospital, contact the Office of the Texas Attorney General Consumer Protection Division 1-800-621-0508 or visit http://www.oag.state.tx.us. For a copy of a hospital’s community benefits plan, contact the Bureau of State Health Data and Policy Analysis at (512) 458-7261. For questions about the County Indigent Health Care Program, contact Texas Department of State Health Services at (512) 458-7706 or visit http://www.tdh.state.tx.us/cihcp.

What you need to know

about . . .

What you need to know

about . . .

CHARITY CARE CHARITY CARE

14

Charity care is defined as free or reduced cost health care provided to those who have no health insurance or who cannot afford to pay for health care. In Texas, each public and non-profit hospital is required to provide a cer-tain amount of charity care. In addition, for-profit hospitals, although not required under Texas law to provide charity care, often have charity care or financial assistance programs. Finally, regardless of the type of hospital, every hospital with an emergency room must treat people who are diag-nosed by licensed physicians as requiring emergency services, regardless of their ability to pay. What this means to you . . . You may be eligible for free or reduced cost health care at certain hospitals in your community. Although anyone can apply for charity care, hospitals have a right to ask financial questions to determine a patient’s eligibility. Patients wishing to apply for charity care must provide all requested finan-cial information to the hospital. Each hospital will establish its own eligi-bility criteria, within certain legal guidelines, but are always based on a patient’s ability to pay. It is important to remember that charity care programs are not a substitute for health insurance or for any government health assistance programs. Hospitals will usually accept insurance first (including Medicare or Medi-caid) and provide charity care only if you have no insurance and cannot afford to pay. Most public and non-profit hospitals provide notice of their charity care programs and how to apply. If you are unsure whether a hospital offers charity care, ask an admissions clerk or billing department representative.

Resources . . . If you think you may qualify for a charity care program, ask the hospital for its policies and application process. To file a complaint or ask questions about a particular hospital, contact the Office of the Texas Attorney General Consumer Protection Division 1-800-621-0508 or visit http://www.oag.state.tx.us. For a copy of a hospital’s community benefits plan, contact the Bureau of State Health Data and Policy Analysis at (512) 458-7261. For questions about the County Indigent Health Care Program, contact Texas Department of State Health Services at (512) 458-7706 or visit http://www.tdh.state.tx.us/cihcp.

What you need to know

about . . .

What you need to know

about . . .

CHARITY CARE CHARITY CARE

15

What you need to know

about . . .

What you need to know

about . . .

YOUR RIGHTS WHILEYOUR RIGHTS WHILE RECEIVING VOLUNTARY INPATIENT RECEIVING VOLUNTARY INPATIENT

MENTAL HEALTH SERVICESMENTAL HEALTH SERVICES All people have certain basic legal rights, including people who have mental illness and people who are voluntarily receiving treatment in men-tal health facilities. Your rights include: (i) the right to ask your treatment team to decide if you need to stay at the facility or if you are ready to leave; and, (ii) the right to leave the facility within 4 hours after you sign a written request to leave, unless the hospital files an involuntary commit-ment application. Nobody can ask a judge to order you to stay at a facility while you are a voluntary patient, except for two reasons: First, the physician can ask for court-ordered mental health services if he or she thinks you need to be committed. A judge may decide that you need to be committed because you will hurt yourself or others if you are not committed. The judge may also decide that you need to be committed if your physician believes that you will suffer distress and become unable to take care of yourself if you are not committed. Second, the physician can ask for court-ordered mental health services if you refuse necessary treatment, or if you are not able to agree to treatment and your physician thinks that you need treatment. The judge may com-mit you if you are likely to hurt yourself or others if you are not commit-ted. The judge may also commit you if your physician testifies that he or she believes that you will suffer distress and become unable to take care of yourself if you are not committed. When the hospital decides you are ready to be discharged, you can decide if you want the staff to tell your family the date of your discharge. If you do not agree that the staff can tell your family that you are being dis-charged, they cannot do so. Resources . . . If you believe one of your rights has been violated, you should contact your treatment team, the facility's Consumer Rights Officer, Office of Consumer Services and Rights Protection, the Public Responsibility Committee, and/or Advocacy, Incorporated at 1-800-252-9108. If you have a complaint of abuse or neglect, call the Texas Department of Pro-tective and Regulatory Services at 1-800-252-5400. 15

What you need to know

about . . .

What you need to know

about . . .

YOUR RIGHTS WHILEYOUR RIGHTS WHILE RECEIVING VOLUNTARY INPATIENT RECEIVING VOLUNTARY INPATIENT

MENTAL HEALTH SERVICESMENTAL HEALTH SERVICES All people have certain basic legal rights, including people who have mental illness and people who are voluntarily receiving treatment in men-tal health facilities. Your rights include: (i) the right to ask your treatment team to decide if you need to stay at the facility or if you are ready to leave; and, (ii) the right to leave the facility within 96 hours after you sign a written request to leave, unless the hospital files an involuntary commit-ment application. Nobody can ask a judge to order you to stay at a facility while you are a voluntary patient, except for two reasons: First, the physician can ask for court-ordered mental health services if he or she thinks you need to be committed. A judge may decide that you need to be committed because you will hurt yourself or others if you are not committed. The judge may also decide that you need to be committed if your physician believes that you will suffer distress and become unable to take care of yourself if you are not committed. Second, the physician can ask for court-ordered mental health services if you refuse necessary treatment, or if you are not able to agree to treatment and your physician thinks that you need treatment. The judge may com-mit you if you are likely to hurt yourself or others if you are not commit-ted. The judge may also commit you if your physician testifies that he or she believes that you will suffer distress and become unable to take care of yourself if you are not committed. When the hospital decides you are ready to be discharged, you can decide if you want the staff to tell your family the date of your discharge. If you do not agree that the staff can tell your family that you are being dis-charged, they cannot do so. Resources . . . If you believe one of your rights has been violated, you should contact your treatment team, the facility's Consumer Rights Officer, Office of Consumer Services and Rights Protection, the Public Responsibility Committee, and/or Advocacy, Incorporated at 1-800-252-9108. If you have a complaint of abuse or neglect, call the Texas Department of Pro-tective and Regulatory Services at 1-800-252-5400.

16

All people have certain basic legal rights, including people who have men-tal illness and who are involuntarily committed to a mental health facility. In some cases, these rights can be restricted by a judge or your physician. Your rights are summarized below. What You Should Know About Receiving Involuntary Inpatient Men-tal Health Treatment You have some rights that no one, not even a judge or a physician, can take away from you: • The right to treatment in the least restrictive appropriate setting. This

means you have the right to treatment in a place that restricts your day-to-day life only as much as is necessary to protect you and others around you. It also means that your treatment should interfere as little as possible with your thinking, with taking care of your personal needs, or with your ability to work.

• The right to a humane treatment environment that is clean and safe.

• The right to proper mental health and medical treatment.

• The right to an independent evaluation by another physician of your choice, as long as you pay the cost.

• The right to enough privacy for your personal needs, as long as this does not place you or other people in danger.

• The right to be told about your rights within one day (24 hours) of your admission to the facility in the language or medium you under-stand best. If you are a minor, or if you have a guardian, information about these rights must also be given to your parent or guardian.

• The right to a written individual treatment plan based on your needs that describes your diagnosis, specific problems and specific needs.

• The right to participate in the development of your treatment plan, if

What you need to know

about . . .

What you need to know

about . . .

YOUR RIGHTS WHILE RECEIVINGYOUR RIGHTS WHILE RECEIVING INVOLUNTARY INPATIENTINVOLUNTARY INPATIENT MENTAL HEALTH SERVICESMENTAL HEALTH SERVICES

16

All people have certain basic legal rights, including people who have men-tal illness and who are involuntarily committed to a mental health facility. In some cases, these rights can be restricted by a judge or your physician. Your rights are summarized below. What You Should Know About Receiving Involuntary Inpatient Men-tal Health Treatment You have some rights that no one, not even a judge or a physician, can take away from you: • The right to treatment in the least restrictive appropriate setting. This

means you have the right to treatment in a place that restricts your day-to-day life only as much as is necessary to protect you and others around you. It also means that your treatment should interfere as little as possible with your thinking, with taking care of your personal needs, or with your ability to work.

• The right to a humane treatment environment that is clean and safe.

• The right to proper mental health and medical treatment.

• The right to an independent evaluation by another physician of your choice, as long as you pay the cost.

• The right to enough privacy for your personal needs, as long as this does not place you or other people in danger.

• The right to be told about your rights within one day (24 hours) of your admission to the facility in the language or medium you under-stand best. If you are a minor, or if you have a guardian, information about these rights must also be given to your parent or guardian.

• The right to a written individual treatment plan based on your needs that describes your diagnosis, specific problems and specific needs.

• The right to participate in the development of your treatment plan, if

What you need to know

about . . .

What you need to know

about . . .

YOUR RIGHTS WHILE RECEIVINGYOUR RIGHTS WHILE RECEIVING INVOLUNTARY INPATIENTINVOLUNTARY INPATIENT MENTAL HEALTH SERVICESMENTAL HEALTH SERVICES

17

you want to participate. If you are under 16 years-old, or if you have a guardian, your parent or guardian can also participate in develop-ing your treatment plan.

• The right to information about the medications your physician has prescribed, including the name of the medication, the dosage and schedule, the type of medication, the benefits expected from that type of medication, and the side effects and risks of the medication.

• The right to refuse to be a part of a research program. You do not have to agree to try new, experimental drugs or treatment.

• The right to be informed, in writing, at admissions and discharges, of Advocacy, Incorporated's address and telephone number.

• The right to send and receive uncensored mail.

• The right to find a lawyer to represent you, and the right to talk by telephone or uncensored mail to your lawyer.

• The right to have your family notified of your discharge, if you want them to know.

• The right to refuse electroconvulsive therapy (ECT). However, if you are 16 years-old or older, and a judge has decided that you are incompetent, then your guardian can consent to ECT but only if you would have agreed to the treatment if you were not incompetent. If you are under 16 years-old, ECT may not be used under any circum-stances.

• The right of habeas corpus. In certain cases, you can ask a judge to decide if it is legal to keep you in a mental health facility against your will. If the judge decides that you should not be kept against your will, you must be immediately discharged from the facility.

Rights That Can Be Restricted Only by a Judge

Unless a judge has held a hearing and made a written order restricting your rights, you have the following rights:

• To register and vote in elections.

• To buy and sell property and to sign contracts.

• To sue and be sued.

• To have a driver's license and other kinds of permits, privileges, and

17

you want to participate. If you are under 16 years-old, or if you have a guardian, your parent or guardian can also participate in develop-ing your treatment plan.

• The right to information about the medications your physician has prescribed, including the name of the medication, the dosage and schedule, the type of medication, the benefits expected from that type of medication, and the side effects and risks of the medication.

• The right to refuse to be a part of a research program. You do not have to agree to try new, experimental drugs or treatment.

• The right to be informed, in writing, at admissions and discharges, of Advocacy, Incorporated's address and telephone number.

• The right to send and receive uncensored mail.

• The right to find a lawyer to represent you, and the right to talk by telephone or uncensored mail to your lawyer.

• The right to have your family notified of your discharge, if you want them to know.

• The right to refuse electroconvulsive therapy (ECT). However, if you are 16 years-old or older, and a judge has decided that you are incompetent, then your guardian can consent to ECT but only if you would have agreed to the treatment if you were not incompetent. If you are under 16 years-old, ECT may not be used under any circum-stances.

• The right of habeas corpus. In certain cases, you can ask a judge to decide if it is legal to keep you in a mental health facility against your will. If the judge decides that you should not be kept against your will, you must be immediately discharged from the facility.

Rights That Can Be Restricted Only by a Judge

Unless a judge has held a hearing and made a written order restricting your rights, you have the following rights:

• To register and vote in elections.

• To buy and sell property and to sign contracts.

• To sue and be sued.

• To have a driver's license and other kinds of permits, privileges, and

18

benefits under the law.

• To religious freedom.

• To have your medical records kept confidential, unless you sign a release or file a lawsuit, or the court orders release of your records.

• All rights concerning your family, such as the right to marry and have children. Unless a judge has taken custody of your children away from you, you can still make decisions for your children.

• To give consent or refuse to give consent to treatment with medica-

tion. If you refuse to consent to medication and you are in a state hospital, you cannot be forced to take medication unless the hospi-tal gets a court order, or you are having a medication-related emer-gency.

Rights That Can Be Restricted Only by a Physician or Treatment Team

Your physician or treatment team can restrict some of your rights while you are receiving involuntary mental health services in a mental health facility:

Only your physician can order that physical restraints be used on you. If restraints are ordered, they must be taken off as soon as possible. Any-time physical restraints are used on you, it must be noted in your medi-cal record by your physician.

Unless your physician says in your records that you cannot do the fol-lowing, you have these rights:

• To wear your own clothes and use your personal belongings.

• To have visitors in the facility, to talk by telephone, or write to peo-ple outside the facility. Your letters must not be opened, read, or changed by anyone in the facility unless you want them to be. The physician can sometimes limit your right to have visitors and to write and talk with other people if the reasons for limiting these rights are put in your medical record. Even if the physician does set limits, you always have the right to talk with and to write with con-fidentiality to a lawyer who has agreed to represent you.

• To socialize with others, including the opposite sex; but your physi-cian may order these activities to be supervised.

18

benefits under the law.

• To religious freedom.

• To have your medical records kept confidential, unless you sign a release or file a lawsuit, or the court orders release of your records.

• All rights concerning your family, such as the right to marry and have children. Unless a judge has taken custody of your children away from you, you can still make decisions for your children.

• To give consent or refuse to give consent to treatment with medica-

tion. If you refuse to consent to medication and you are in a state hospital, you cannot be forced to take medication unless the hospi-tal gets a court order, or you are having a medication-related emer-gency.

Rights That Can Be Restricted Only by a Physician or Treatment Team

Your physician or treatment team can restrict some of your rights while you are receiving involuntary mental health services in a mental health facility:

Only your physician can order that physical restraints be used on you. If restraints are ordered, they must be taken off as soon as possible. Any-time physical restraints are used on you, it must be noted in your medi-cal record by your physician.

Unless your physician says in your records that you cannot do the fol-lowing, you have these rights:

• To wear your own clothes and use your personal belongings.

• To have visitors in the facility, to talk by telephone, or write to peo-ple outside the facility. Your letters must not be opened, read, or changed by anyone in the facility unless you want them to be. The physician can sometimes limit your right to have visitors and to write and talk with other people if the reasons for limiting these rights are put in your medical record. Even if the physician does set limits, you always have the right to talk with and to write with con-fidentiality to a lawyer who has agreed to represent you.

• To socialize with others, including the opposite sex; but your physi-cian may order these activities to be supervised.

19

• To physical activity and grounds privileges.

• The right, when you are discharged, to a plan for your continued treatment that covers both your mental health and physical needs. You have the right to refuse the services in this plan, unless a judge orders you to receive outpatient treatment.

Resources . . .

If you think your rights may have been violated, you should first contact your treatment team at the facility where you are located. Additionally, you have the right to talk to any of the following:

• the Consumer Rights Officer, located at all mental health facilities;

• the Texas Department of State Health Services Office of Consumer Services and Rights Protection at (512) 206-5760; and,

• the Public Responsibility Committee, and/or Advocacy, Incorporated at 1-800-252-9108.

19

• To physical activity and grounds privileges.

• The right, when you are discharged, to a plan for your continued treatment that covers both your mental health and physical needs. You have the right to refuse the services in this plan, unless a judge orders you to receive outpatient treatment.

Resources . . .

If you think your rights may have been violated, you should first contact your treatment team at the facility where you are located. Additionally, you have the right to talk to any of the following:

• the Consumer Rights Officer, located at all mental health facilities;

• the Texas Department of State Health Services Office of Consumer Services and Rights Protection at (512) 206-5760; and,

• the Public Responsibility Committee, and/or Advocacy, Incorporated at 1-800-252-9108.

20

Even when you are committed to a public or private psychiatric hospital, you have the right to refuse medications for the treatment of mental ill-ness. Under certain circumstances, your right to refuse medication may be restricted by a physician or a judge. What You Should Know About the Legal Right to Refuse Psychotro-pic Medication You can refuse such medication if you are in a hospital for psychiatric care under an emergency commitment, a voluntary commitment, or under an order of protective custody. You can be required to take such medication under the following circum-stances: • There is an emergency because your recent behavior shows you are

likely to hurt yourself or others; or

• You are under 16 years-old and your guardian or parent consents for you; or

• You are involuntarily committed under a 90-day commitment order and a judge decides you are likely to hurt yourself or others, cannot make this decision for yourself, and that the medication will help you get well.

Before You Consent To Medication You must be told certain information, both orally and in writing, in the language or medium you understand best. If you have a guardian or you are under 16 years-old, then your guardian or parent must also be given this information. You must be told: • The specific condition being treated with the medication;

What you need to know

about . . .

What you need to know

about . . .

YOUR RIGHT TO REFUSEYOUR RIGHT TO REFUSE PSYCHOTROPIC MEDICATION PSYCHOTROPIC MEDICATION

20

Even when you are committed to a public or private psychiatric hospital, you have the right to refuse medications for the treatment of mental ill-ness. Under certain circumstances, your right to refuse medication may be restricted by a physician or a judge. What You Should Know About the Legal Right to Refuse Psychotro-pic Medication You can refuse such medication if you are in a hospital for psychiatric care under an emergency commitment, a voluntary commitment, or under an order of protective custody. You can be required to take such medication under the following circum-stances: • There is an emergency because your recent behavior shows you are

likely to hurt yourself or others; or

• You are under 16 years-old and your guardian or parent consents for you; or

• You are involuntarily committed under a 90-day commitment order and a judge decides you are likely to hurt yourself or others, cannot make this decision for yourself, and that the medication will help you get well.

Before You Consent To Medication You must be told certain information, both orally and in writing, in the language or medium you understand best. If you have a guardian or you are under 16 years-old, then your guardian or parent must also be given this information. You must be told: • The specific condition being treated with the medication;

What you need to know

about . . .

What you need to know

about . . .

YOUR RIGHT TO REFUSEYOUR RIGHT TO REFUSE PSYCHOTROPIC MEDICATION PSYCHOTROPIC MEDICATION

21

• How the medication will help that condition;

• What might happen to your mental health if you refuse the medica-tion;

• Any significant side effects and risks you may have if you take the medication;

• Any alternatives to taking the medication and why the physician thinks they will not work as well for you;

• How long and how often you will be taking the medication; and,

• If you decide to take the medication, you can change your mind at any time.

You also have the right to have an independent examination or evalua-tion by another physician of your choice at your own cost. If you ask for an independent examination or evaluation, it must be arranged for you by the hospital. If you consent to take medication, your consent must be voluntary and uncoerced. If You Decide To Refuse Medication You cannot be forced to take medication unless it is an emergency. In a non-emergency situation, if you refuse medication, your physician must file an application with the court for an order authorizing the admini-stration of psychotropic medication. At the medication hearing: • You may be represented by a lawyer--one will be appointed by the

court, if necessary.

• The judge will listen to what you and your physician have to say, and determine if you lack the capacity to make a decision about whether to take the medication, and if treatment with the medica-tion is in your best interest.

• To determine what is in your best interest, the judge must consider:

21

• How the medication will help that condition;

• What might happen to your mental health if you refuse the medica-tion;

• Any significant side effects and risks you may have if you take the medication;

• Any alternatives to taking the medication and why the physician thinks they will not work as well for you;

• How long and how often you will be taking the medication; and,

• If you decide to take the medication, you can change your mind at any time.

You also have the right to have an independent examination or evalua-tion by another physician of your choice at your own cost. If you ask for an independent examination or evaluation, it must be arranged for you by the hospital. If you consent to take medication, your consent must be voluntary and uncoerced. If You Decide To Refuse Medication You cannot be forced to take medication unless it is an emergency. In a non-emergency situation, if you refuse medication, your physician must file an application with the court for an order authorizing the admini-stration of psychotropic medication. At the medication hearing: • You may be represented by a lawyer--one will be appointed by the

court, if necessary.

• The judge will listen to what you and your physician have to say, and determine if you lack the capacity to make a decision about whether to take the medication, and if treatment with the medica-tion is in your best interest.

• To determine what is in your best interest, the judge must consider:

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1. your expressed preferences regarding treatment with psychoac-tive medication (If you have a Psychiatric Advance Directive, the judge has to consider it.);

2. your religious beliefs;

3. the risks and benefits, from your perspective, of taking psy-choactive medication;

4. the consequences to you if the psychoactive medication is not administered;

5. your prognosis if you are treated with psychoactive medication; and,

6. alternatives to treatment with psychoactive medication. • After the judge makes a decision, you can appeal the decision. If a judge has decided that you must take medication, you have to take it until your 90-day commitment order has ended. Your physician can in-crease or lower the dosage of your medication, and can give you another medication in the same class without additional approval from the court. But the class (or classes) of medication you have been ordered to take cannot be changed without a court order. The class (or classes) of medi-cations approved by the court will be attached to the order. Resources . . . If you believe your right to refuse psychotropic medication has been vio-lated, you should first contact your treatment team at the facility where you are hospitalized. Additionally, you have the right to talk to any of the following: • the Client Rights Officer, located at all mental health facilities;

• the Texas Department of State Health Services Office of Consumer Services and Rights Protection at (512) 206-5760;

• the Public Responsibility Committee at 1-800-252-9108; and,

• Texas Mental Health Consumers (1-800-860-6057); and/or Advo-cacy, Incorporated (800-252-9108).

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1. your expressed preferences regarding treatment with psychoac-tive medication (If you have a Psychiatric Advance Directive, the judge has to consider it.);

2. your religious beliefs;

3. the risks and benefits, from your perspective, of taking psy-choactive medication;

4. the consequences to you if the psychoactive medication is not administered;

5. your prognosis if you are treated with psychoactive medication; and,

6. alternatives to treatment with psychoactive medication. • After the judge makes a decision, you can appeal the decision. If a judge has decided that you must take medication, you have to take it until your 90-day commitment order has ended. Your physician can in-crease or lower the dosage of your medication, and can give you another medication in the same class without additional approval from the court. But the class (or classes) of medication you have been ordered to take cannot be changed without a court order. The class (or classes) of medi-cations approved by the court will be attached to the order. Resources . . . If you believe your right to refuse psychotropic medication has been vio-lated, you should first contact your treatment team at the facility where you are hospitalized. Additionally, you have the right to talk to any of the following: • the Client Rights Officer, located at all mental health facilities;

• the Texas Department of State Health Services Office of Consumer Services and Rights Protection at (512) 206-5760;

• the Public Responsibility Committee at 1-800-252-9108; and,

• Texas Mental Health Consumers (1-800-860-6057); and/or Advo-cacy, Incorporated (800-252-9108).

© Health Law Council, State Bar of Texas, 2005. All Rights Reserved. Please contact the Health Law Council of the State Bar of Texas for permission to reprint this brochure. For more information on the Health Law Council, please go to http://www.texhealthlaw.org/.

© Health Law Council, State Bar of Texas, 2005. All Rights Reserved. Please contact the Health Law Council of the State Bar of Texas for permission to reprint this brochure. For more information on the Health Law Council, please go to http://www.texhealthlaw.org/.