Minnesota Session Laws - 1983, Regular Session

  

                         Laws of Minnesota 1983 

                        CHAPTER 248--H.F.No. 365
           An act relating to health care facilities; clarifying 
          the rights and responsibilities of patients and 
          residents; amending Minnesota Statutes 1982, sections 
          144.651; 144.652; and 145.93, subdivision 3.  
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:  
    Section 1.  Minnesota Statutes 1982, section 144.651, is 
amended to read:  
    144.651 [PATIENTS AND RESIDENTS OF HEALTH CARE FACILITIES; 
BILL OF RIGHTS.] 
    Subdivision 1.  [LEGISLATIVE INTENT.] It is the intent of 
the legislature and the purpose of this section to promote the 
interests and well being of the patients and residents of health 
care facilities.  No health care facility may require a patient 
or resident to waive these rights as a condition of admission to 
the facility.  Any guardian or conservator of a patient or 
resident or, in the absence of a guardian or conservator, an 
interested person, may seek enforcement of these rights on 
behalf of a patient or resident.  It is the intent of this 
section that every patient's civil and religious liberties, 
including the right to independent personal decisions and 
knowledge of available choices, shall not be infringed and that 
the facility shall encourage and assist in the fullest possible 
exercise of these rights. 
    Subd. 2.  [DEFINITIONS.] For the purposes of this section, 
"patient" means a person who is admitted to an acute care 
inpatient facility for a continuous period longer than 24 hours, 
for the purpose of diagnosis or treatment bearing on the 
physical or mental health of that person.  "Resident" means a 
person who is admitted to a nonacute care facility including 
extended care facilities, nursing homes, and board and care 
homes for care required because of prolonged mental or physical 
illness or disability, recovery from injury or disease, or 
advancing age.  
    Subd. 3.  [PUBLIC POLICY DECLARATION.] It is declared to be 
the public policy of this state that the interests of each 
patient and resident be protected by a declaration of a 
patients' bill of rights which shall include but not be limited 
to the following:  
    (1) Every patient and resident shall have the right to 
considerate and respectful care;  
    (2) Every patient and resident can reasonably expect to 
obtain from his physician or the resident physician of the 
facility complete and current information concerning his 
diagnosis, treatment and prognosis in terms and language the 
patient can reasonably be expected to understand.  In cases in 
which it is not medically advisable to give the information to 
the patient or resident the information may be made available to 
the appropriate person in his behalf;  
    (3) Every patient and resident shall have the right to know 
by name and specialty, if any, the physician responsible for 
coordination of his care;  
    (4) Every patient and resident shall have the right to 
every consideration of his privacy and individuality as it 
relates to his social, religious, and psychological well being;  
    (5) Every patient and resident shall have the right to 
respectfulness and privacy as it relates to his medical care 
program.  Case discussion, consultation, examination, and 
treatment are confidential and should be conducted discreetly;  
    (6) Every patient and resident shall have the right to 
expect the facility to make a reasonable response to his 
requests;  
    (7) Every patient and resident shall have the right to 
obtain information as to any relationship of the facility to 
other health care and related institutions insofar as his care 
is concerned;  
    (8) Every patient and resident shall have the right to 
expect reasonable continuity of care which shall include but not 
be limited to what appointment times and physicians are 
available;  
    (9) Every resident shall be fully informed, prior to or at 
the time of admission and during his stay, of services available 
in the facility, and of related charges including any charges 
for services not covered under medicare or medicaid or not 
covered by the facility's basic per diem rate;  
    (10) Every patient and resident shall be afforded the 
opportunity to participate in the planning of his medical 
treatment and to refuse to participate in experimental research; 
    (11) No resident shall be arbitrarily transferred or 
discharged but may be transferred or discharged only for medical 
reasons, for his or other residents' welfare, or for nonpayment 
for stay unless prohibited by the welfare programs paying for 
the care of the resident, as documented in the medical record. 
Reasonable advance notice of any transfer or discharge must be 
given to a resident;  
    (12) Every resident may manage his personal financial 
affairs, or shall be given at least a quarterly accounting of 
financial transactions on his behalf if he delegates this 
responsibility in accordance with the laws of Minnesota to the 
facility for any period of time;  
    (13) Every resident shall be encouraged and assisted, 
throughout his period of stay in a facility, to understand and 
exercise his rights as a patient and as a citizen, and to this 
end, he may voice grievances and recommend changes in policies 
and services to facility staff and outside representatives of 
his choice, free from restraint, interference, coercion, 
discrimination or reprisal;  
    (14) Every resident shall be free from mental and physical 
abuse, and free from chemical and physical restraints, except in 
emergencies, or as authorized in writing by his physician for a 
specified and limited period of time, and when necessary to 
protect the resident from injury to himself or to others;  
    (15) Every patient and resident shall be assured 
confidential treatment of his personal and medical records, and 
may approve or refuse their release to any individual outside 
the facility, except as otherwise provided by law or a third 
party payment contract;  
    (16) No resident shall be required to perform services for 
the facility that are not included for therapeutic purposes in 
his plan of care;  
    (17) Every resident may associate and communicate privately 
with persons of his choice, and send and receive his personal 
mail unopened, unless medically contraindicated and documented 
by his physician in the medical record;  
    (18) Every resident may meet with representatives and 
participate in activities of commercial, religious, and 
community groups at his discretion; provided, however, that the 
activities shall not infringe upon the right to privacy of other 
residents;  
    (19) Every resident may retain and use his personal 
clothing and possessions as space permits, unless to do so would 
infringe upon rights of other patients or residents, and unless 
medically contraindicated and documented by his physician in the 
medical record;  
    (20) Every resident, if married, shall be assured privacy 
for visits by his or her spouse and if both spouses are 
residents of the facility, they shall be permitted to share a 
room, unless medically contraindicated and documented by their 
physicians in the medical record;  
    (21) Every patient or resident shall be fully informed, 
prior to or at the time of admission and during his stay at a 
facility, of the rights and responsibilities set forth in this 
section and of all rules governing patient conduct and 
responsibilities; and 
    (22) Every patient or resident suffering from any form of 
breast cancer shall be fully informed, prior to or at the time 
of admission and during her stay, of all alternative effective 
methods of treatment of which the treating physician is 
knowledgeable, including surgical, radiological, or 
chemotherapeutic treatments or combinations of treatments and 
the risks associated with each of those methods rights specified 
in this section. 
    Subd. 4.  [INFORMATION ABOUT RIGHTS.] Patients and 
residents shall, at admission, be told that there are legal 
rights for their protection during their stay at the facility 
and that these are described in an accompanying written 
statement of the applicable rights and responsibilities set 
forth in this section.  Reasonable arrangements shall be made 
for those with communication impairments and those who speak a 
language other than English.  Current facility policies, 
inspection findings of state and local health authorities, and 
further explanation of the written statement of rights shall be 
available to patients, residents, their guardians or their 
chosen representatives upon reasonable request to the 
administrator or other designated staff person.  
    Subd. 5.  [COURTEOUS TREATMENT.] Patients and residents 
have the right to be treated with courtesy and respect for their 
individuality by employees of or persons providing service in a 
health care facility.  
    Subd. 6.  [APPROPRIATE HEALTH CARE.] Patients and residents 
shall have the right to appropriate medical and personal care 
based on individual needs.  Appropriate care for residents means 
care designed to enable residents to achieve their highest level 
of physical and mental functioning.  This right is limited where 
the service is not reimbursable by public or private resources.  
    Subd. 7.  [PHYSICIAN'S IDENTITY.] Patients and residents 
shall have or be given, in writing, the name, business address, 
telephone number, and specialty, if any, of the physician 
responsible for coordination of their care.  In cases where it 
is medically inadvisable, as documented by the attending 
physician in a patient's or resident's care record, the 
information shall be given to the patient's or resident's 
guardian or other person designated by the patient or resident 
as his or her representative.  
    Subd. 8.  [RELATIONSHIP WITH OTHER HEALTH SERVICES.] 
Patients and residents who receive services from an outside 
provider are entitled, upon request, to be told the identity of 
the provider.  Residents shall be informed, in writing, of any 
health care services which are provided to those residents by 
individuals, corporations, or organizations other than their 
facility.  Information shall include the name of the outside 
provider, the address, and a description of the service which 
may be rendered.  In cases where it is medically inadvisable, as 
documented by the attending physician in a patient's or 
resident's care record, the information shall be given to the 
patient's or resident's guardian or other person designated by 
the patient or resident as his or her representative.  
    Subd. 9.  [INFORMATION ABOUT TREATMENT.] Patients and 
residents shall be given by their physicians complete and 
current information concerning their diagnosis, treatment, 
alternatives, risks, and prognosis as required by the 
physician's legal duty to disclose.  This information shall be 
in terms and language the patients or residents can reasonably 
be expected to understand.  Patients and residents may be 
accompanied by a family member or other chosen representative. 
This information shall include the likely medical or major 
psychological results of the treatment and its alternatives.  In 
cases where it is medically inadvisable, as documented by the 
attending physician in a patient's or resident's medical record, 
the information shall be given to the patient's or resident's 
guardian or other person designated by the patient or resident 
as his or her representative.  Individuals have the right to 
refuse this information.  
     Subd. 10.  [PARTICIPATION IN PLANNING TREATMENT.] Patients 
and residents shall have the right to participate in the 
planning of their health care.  This right includes the 
opportunity to discuss treatment and alternatives with 
individual caregivers, the opportunity to request and 
participate in formal care conferences, and the right to include 
a family member or other chosen representative.  In the event 
that the patient or resident cannot be present, a family member 
or other representative chosen by the patient or resident may be 
included in such conferences.  
    Subd. 11.  [CONTINUITY OF CARE.] Patients and residents 
shall have the right to be cared for with reasonable regularity 
and continuity of staff assignment as far as facility policy 
allows.  
    Subd. 12.  [RIGHT TO REFUSE CARE.] Competent patients and 
residents shall have the right to refuse treatment based on the 
information required in subdivision 9.  Residents who refuse 
treatment, medication, or dietary restrictions shall be informed 
of the likely medical or major psychological results of the 
refusal, with documentation in the individual medical record. In 
cases where a patient or resident is incapable of understanding 
the circumstances but has not been adjudicated incompetent, or 
when legal requirements limit the right to refuse treatment, the 
conditions and circumstances shall be fully documented by the 
attending physician in the patient's or resident's medical 
record.  
    Subd. 13.  [EXPERIMENTAL RESEARCH.] Written, informed 
consent must be obtained prior to a patient's or resident's 
participation in experimental research.  Patients and residents 
have the right to refuse participation.  Both consent and 
refusal shall be documented in the individual care record.  
     Subd. 14.  [FREEDOM FROM ABUSE.] Patients and residents 
shall be free from mental and physical abuse as defined in the 
Vulnerable Adults Protection Act.  "Abuse" means any act which 
constitutes assault, sexual exploitation, or criminal sexual 
conduct as described in section 626.557, subdivision 2d, or the 
intentional and nontherapeutic infliction of physical pain or 
injury, or any persistent course of conduct intended to produce 
mental or emotional distress.  Every patient and resident shall 
also be free from nontherapeutic chemical and physical 
restraints, except in fully documented emergencies, or as 
authorized in writing after examination by a patient's or 
resident's physician for a specified and limited period of time, 
and only when necessary to protect the resident from self-injury 
or injury to others.  
    Subd. 15.  [TREATMENT PRIVACY.] Patients and residents 
shall have the right to respectfulness and privacy as it relates 
to their medical and personal care program.  Case discussion, 
consultation, examination, and treatment are confidential and 
shall be conducted discreetly.  Privacy shall be respected 
during toileting, bathing, and other activities of personal 
hygiene, except as needed for patient or resident safety or 
assistance.  
     Subd. 16.  [CONFIDENTIALITY OF RECORDS.] Patients and 
residents shall be assured confidential treatment of their 
personal and medical records, and may approve or refuse their 
release to any individual outside the facility.  Residents shall 
be notified when personal records are requested by any 
individual outside the facility and may select someone to 
accompany them when the records or information are the subject 
of a personal interview.  Copies of records and written 
information from the records shall be made available in 
accordance with this subdivision and section 144.335.  This 
right does not apply to complaint investigations and inspections 
by the department of health, where required by third party 
payment contracts, or where otherwise provided by law.  
    Subd. 17.  [DISCLOSURE OF SERVICES AVAILABLE.] Patients and 
residents shall be informed, prior to or at the time of 
admission and during their stay, of services which are included 
in the facility's basic per diem or daily room rate and that 
other services are available at additional charges.  Facilities 
shall make every effort to assist patients and residents in 
obtaining information regarding whether the medicare or medical 
assistance program will pay for any or all of the aforementioned 
services.  
    Subd. 18.  [RESPONSIVE SERVICE.] Patients and residents 
shall have the right to a prompt and reasonable response to 
their questions and requests.  
    Subd. 19.  [PERSONAL PRIVACY.] Patients and residents shall 
have the right to every consideration of their privacy, 
individuality, and cultural identity as related to their social, 
religious, and psychological well-being.  Facility staff shall 
respect the privacy of a resident's room by knocking on the door 
and seeking consent before entering, except in an emergency or 
where clearly inadvisable.  
    Subd. 20.  [GRIEVANCES.] Patients and residents shall be 
encouraged and assisted, throughout their stay in a facility, to 
understand and exercise their rights as patients, residents, and 
citizens.  Patients and residents may voice grievances and 
recommend changes in policies and services to facility staff and 
others of their choice, free from restraint, interference, 
coercion, discrimination, or reprisal, including threat of 
discharge.  Notice of the facility's grievance procedure, as 
well as addresses and telephone numbers for the office of health 
facility complaints and the area nursing home ombudsman pursuant 
to the Older Americans Act, section 307(a)(12) shall be posted 
in a conspicuous place.  
    Subd. 21.  [COMMUNICATION PRIVACY.] Patients and residents 
may associate and communicate privately with persons of their 
choice and enter and, except as provided by the Minnesota 
Commitment Act, leave the facility as they choose.  Patients and 
residents shall have access, at their expense, to writing 
instruments, stationery, and postage.  Personal mail shall be 
sent without interference and received unopened unless medically 
or programmatically contraindicated and documented by the 
physician in the medical record.  There shall be access to a 
telephone where patients and residents can make and receive 
calls as well as speak privately.  Facilities which are unable 
to provide a private area shall make reasonable arrangements to 
accommodate the privacy of patients' or residents' calls.  This 
right is limited where medically inadvisable, as documented by 
the attending physician in a patient's or resident's care 
record.  Where programmatically limited by a facility abuse 
prevention plan pursuant to section 626.557, subdivision 14, 
clause 2, this right shall also be limited accordingly.  
    Subd. 22.  [PERSONAL PROPERTY.] Patients and residents may 
retain and use their personal clothing and possessions as space 
permits, unless to do so would infringe upon rights of other 
patients or residents, and unless medically or programmatically 
contraindicated for documented medical, safety, or programmatic 
reasons.  The facility must either maintain a central locked 
depository or provide individual locked storage areas in which 
residents may store their valuables for safekeeping.  The 
facility may, but is not required to, provide compensation for 
or replacement of lost or stolen items.  
    Subd. 23.  [SERVICES FOR THE FACILITY.] Patients and 
residents shall not perform labor or services for the facility 
unless those activities are included for therapeutic purposes 
and appropriately goal-related in their individual medical 
record.  
    Subd. 24.  [CHOICE OF SUPPLIER.] A resident may purchase or 
rent goods or services not included in the per diem rate from a 
supplier of his or her choice unless otherwise provided by law. 
The supplier shall ensure that these purchases are sufficient to 
meet the medical or treatment needs of the resident.  
    Subd. 25.  [FINANCIAL AFFAIRS.] Competent residents may 
manage their personal financial affairs, or shall be given at 
least a quarterly accounting of financial transactions on their 
behalf if they delegate this responsibility in accordance with 
the laws of Minnesota to the facility for any period of time.  
    Subd. 26.  [RIGHT TO ASSOCIATE.] Residents may meet with 
visitors and participate in activities of commercial, religious, 
political, as defined in section 203B.11 and community groups 
without interference at their discretion if the activities do 
not infringe on the right to privacy of other residents or are 
not programmatically contraindicated.  This includes the right 
to join with other individuals within and outside the facility 
to work for improvements in long-term care.  
    Subd. 27.  [ADVISORY COUNCILS.] Residents and their 
families shall have the right to organize, maintain, and 
participate in resident advisory and family councils.  Each 
facility shall provide assistance and space for meetings. 
Council meetings shall be afforded privacy, with staff or 
visitors attending only upon the council's invitation.  A staff 
person shall be designated the responsibility of providing this 
assistance and responding to written requests which result from 
council meetings.  Resident and family councils shall be 
encouraged to make recommendations regarding facility policies.  
    Subd. 28.  [MARRIED RESIDENTS.] Residents, if married, 
shall be assured privacy for visits by their spouses and, if 
both spouses are residents of the facility, they shall be 
permitted to share a room, unless medically contraindicated and 
documented by their physicians in the medical records.  
    Subd. 29.  [TRANSFERS AND DISCHARGES.] Residents shall not 
be arbitrarily transferred or discharged.  Residents must be 
notified, in writing, of the proposed discharge or transfer and 
its justification no later than 30 days before discharge from 
the facility and seven days before transfer to another room 
within the facility.  This notice shall include the resident's 
right to contest the proposed action, with the address and 
telephone number of the area nursing home ombudsman pursuant to 
the Older Americans Act, section 307(a)(12).  The resident, 
informed of this right, may choose to relocate before the notice 
period ends.  The notice period may be shortened in situations 
outside the facility's control, such as a determination by 
utilization review, the accommodation of newly-admitted 
residents, a change in the resident's medical or treatment 
program, the resident's own or another resident's welfare, or 
nonpayment for stay unless prohibited by the public program or 
programs paying for the resident's care, as documented in the 
medical record.  Facilities shall make a reasonable effort to 
accommodate new residents without disrupting room assignments.  
    Sec. 2.  Minnesota Statutes 1982, section 144.652, is 
amended to read: 
    144.652 [POLICY STATEMENT BILL OF RIGHTS NOTICE TO PATIENT 
OR RESIDENT; VIOLATION.] 
    Subdivision 1.  [DISTRIBUTION; POSTING.] The policy 
statement contained in Except as provided below, section 144.651 
shall be posted conspicuously in a public place in all 
facilities licensed under the provisions of sections 144.50 to 
144.58, or 144A.02 or any law providing for the licensure of 
nursing homes.  Copies of the policy statement law shall be 
furnished the patient or resident and the patient or resident's 
guardian or conservator upon admittance to the facility.  
Facilities providing services to patients may delete section 
144.651, subdivisions 24 to 29, and those portions of other 
subdivisions that apply only to residents, from copies posted or 
distributed to patients with appropriate notation that residents 
have additional rights under law.  The policy statement shall 
include the address and telephone number of the board of medical 
examiners and/or the name and phone number of the person within 
the facility to whom inquiries about the medical care received 
may be directed.  The notice shall include a brief statement 
describing how to file a complaint with the nursing home 
complaint team of the health department or any division or 
agency of state government which succeeds it office of health 
facility complaints established pursuant to section 144A.52 
concerning a violation of section 144.651 or any other state 
statute or rule.  This notice shall include the address and 
phone number of the office of health facility complaints.  
    Subd. 2.  [CORRECTION ORDER; EMERGENCIES.] A substantial 
violation of the rights of any patient or resident as defined in 
section 144.651, shall be grounds for issuance of a correction 
order pursuant to section 144.653 or 144A.10.  The issuance or 
nonissuance of a correction order shall not preclude, diminish, 
enlarge, or otherwise alter private action by or on behalf of a 
patient or resident to enforce any unreasonable violation of his 
rights.  Compliance with the provisions of section 144.651 shall 
not be required whenever emergency conditions, as documented by 
the attending physician in a patient's medical record or a 
resident's care record, indicate immediate medical treatment, 
including but not limited to surgical procedures, is necessary 
and it is impossible or impractical to comply with the 
provisions of section 144.651 because delay would endanger the 
patient's or resident's life, health, or safety. 
    Sec. 3.  Minnesota Statutes 1982, section 145.93, 
subdivision 3, is amended to read: 
    Subd. 3.  [GRANT AWARD; DESIGNATION; PAYMENTS UNDER GRANT.] 
Each Every odd-numbered year the commissioner shall give 
reasonable public notice of the availability of moneys money 
appropriated pursuant to Laws 1980, Chapter 577, Section 2 or 
otherwise available for the purposes of this section.  After 
consulting with the advisory council, the commissioner shall 
select as grantee a nonprofit corporation or unit of government 
which applies for the moneys and best fulfills the criteria 
specified in subdivision 4.  The grantee selected shall be 
designated the Minnesota poison information center.  Moneys 
Money appropriated under Laws 1980, Chapter 577, Section 2 or 
otherwise available for the purposes of this section shall be 
paid to the grantee quarterly beginning on July 1. 
    Approved June 1, 1983