144.651 HEALTH CARE 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. An interested person may also seek enforcement of these
rights on behalf of a patient or resident who has a guardian or conservator through administrative
agencies or in district court having jurisdiction over guardianships and conservatorships. Pending
the outcome of an enforcement proceeding the health care facility may, in good faith, comply with
the instructions of a guardian or conservator. 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. For
purposes of subdivisions 4 to 9, 12, 13, 15, 16, and 18 to 20, "patient" also means a person who
receives health care services at an outpatient surgical center. "Patient" also means a minor who is
admitted to a residential program as defined in section
. For purposes of subdivisions 1, 3
to 16, 18, 20 and 30, "patient" also means any person who is receiving mental health treatment
on an outpatient basis or in a community support program or other community-based program.
"Resident" means a person who is admitted to a nonacute care facility including extended care
facilities, nursing homes, and boarding care homes for care required because of prolonged
mental or physical illness or disability, recovery from injury or disease, or advancing age. For
purposes of all subdivisions except subdivisions 28 and 29, "resident" also means a person who
is admitted to a facility licensed as a board and lodging facility under Minnesota Rules, parts
, or a supervised living facility under Minnesota Rules, parts 4665.0100
, and which operates a rehabilitation program licensed under Minnesota Rules, parts
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 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 or throughout their course
of treatment and maintenance in the community and that these are described in an accompanying
written statement of the applicable rights and responsibilities set forth in this section. In the case
of patients admitted to residential programs as defined in section
, the written statement
shall also describe the right of a person 16 years old or older to request release as provided in
253B.04, subdivision 2
, and shall list the names and telephone numbers of individuals
and organizations that provide advocacy and legal services for patients in residential programs.
Reasonable accommodations 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, consistent with chapter 13, the Data
Practices Act, and section
, relating to vulnerable adults.
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 a
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 a 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, or both.
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 a representative.
Individuals have the right to refuse this information.
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
Subd. 10. Participation in planning treatment; notification of family members.
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, or both. 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. A chosen representative may include a doula of the patient's choice.
(b) If a patient or resident who enters a facility is unconscious or comatose or is unable to
communicate, the facility shall make reasonable efforts as required under paragraph (c) to notify
either a family member or a person designated in writing by the patient as the person to contact in
an emergency that the patient or resident has been admitted to the facility. The facility shall allow
the family member to participate in treatment planning, unless the facility knows or has reason
to believe the patient or resident has an effective advance directive to the contrary or knows the
patient or resident has specified in writing that they do not want a family member included in
treatment planning. After notifying a family member but prior to allowing a family member
to participate in treatment planning, the facility must make reasonable efforts, consistent with
reasonable medical practice, to determine if the patient or resident has executed an advance
directive relative to the patient or resident's health care decisions. For purposes of this paragraph,
"reasonable efforts" include:
(1) examining the personal effects of the patient or resident;
(2) examining the medical records of the patient or resident in the possession of the facility;
(3) inquiring of any emergency contact or family member contacted under this section
whether the patient or resident has executed an advance directive and whether the patient or
resident has a physician to whom the patient or resident normally goes for care; and
(4) inquiring of the physician to whom the patient or resident normally goes for care, if
known, whether the patient or resident has executed an advance directive. If a facility notifies
a family member or designated emergency contact or allows a family member to participate in
treatment planning in accordance with this paragraph, the facility is not liable to the patient or
resident for damages on the grounds that the notification of the family member or emergency
contact or the participation of the family member was improper or violated the patient's privacy
(c) In making reasonable efforts to notify a family member or designated emergency contact,
the facility shall attempt to identify family members or a designated emergency contact by
examining the personal effects of the patient or resident and the medical records of the patient or
resident in the possession of the facility. If the facility is unable to notify a family member or
designated emergency contact within 24 hours after the admission, the facility shall notify the
county social service agency or local law enforcement agency that the patient or resident has been
admitted and the facility has been unable to notify a family member or designated emergency
contact. The county social service agency and local law enforcement agency shall assist the
facility in identifying and notifying a family member or designated emergency contact. A county
social service agency or local law enforcement agency that assists a facility in implementing this
subdivision is not liable to the patient or resident for damages on the grounds that the notification
of the family member or emergency contact or the participation of the family member was
improper or violated the patient's privacy rights.
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 maltreatment.
Patients and residents shall be free from
maltreatment as defined in the Vulnerable Adults Protection Act. "Maltreatment" means conduct
described in section
626.5572, subdivision 15
, 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 sections
144.298. 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
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
Subd. 20. Grievances.
Patients and residents shall be encouraged and assisted, throughout
their stay in a facility or their course of treatment, 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
grievance procedure of the facility or program, 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.
Every acute care inpatient facility, every residential program as defined in section
every nonacute care facility, and every facility employing more than two people that provides
outpatient mental health services shall have a written internal grievance procedure that, at a
minimum, sets forth the process to be followed; specifies time limits, including time limits for
facility response; provides for the patient or resident to have the assistance of an advocate;
requires a written response to written grievances; and provides for a timely decision by an
impartial decision maker if the grievance is not otherwise resolved. Compliance by hospitals,
residential programs as defined in section
which are hospital-based primary treatment
programs, and outpatient surgery centers with section
and compliance by health
maintenance organizations with section
is deemed to be compliance with the requirement
for a written internal grievance procedure.
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. Upon admission to a facility where federal law prohibits
unauthorized disclosure of patient or resident identifying information to callers and visitors,
the patient or resident, or the legal guardian or conservator of the patient or resident, shall
be given the opportunity to authorize disclosure of the patient's or resident's presence in the
facility to callers and visitors who may seek to communicate with the patient or resident. To
the extent possible, the legal guardian or conservator of a patient or resident shall consider the
opinions of the patient or resident regarding the disclosure of the patient's or resident's presence in
the facility. 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, paragraph (b)
, 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.
Residents may purchase or rent goods or services not included
in the per diem rate from a supplier of their choice unless otherwise provided by law. The
supplier shall ensure that these purchases are sufficient to meet the medical or treatment needs
of the residents.
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.
(a) Residents may meet with and receive visitors and
participate in activities of commercial, religious, political, as defined in section
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:
(1) the right to join with other individuals within and outside the facility to work for
improvements in long-term care;
(2) the right to visitation by an individual the patient has appointed as the patient's health
care agent under chapter 145C;
(3) the right to visitation and health care decision making by an individual designated by the
patient under paragraph (c).
(b) Upon admission to a facility where federal law prohibits unauthorized disclosure of
patient or resident identifying information to callers and visitors, the patient or resident, or the
legal guardian or conservator of the patient or resident, shall be given the opportunity to authorize
disclosure of the patient's or resident's presence in the facility to callers and visitors who may
seek to communicate with the patient or resident. To the extent possible, the legal guardian or
conservator of a patient or resident shall consider the opinions of the patient or resident regarding
the disclosure of the patient's or resident's presence in the facility.
(c) Upon admission to a facility, the patient or resident, or the legal guardian or conservator
of the patient or resident, must be given the opportunity to designate a person who is not related
who will have the status of the patient's next of kin with respect to visitation and making a health
care decision. A designation must be included in the patient's health record. With respect to
making a health care decision, a health care directive or appointment of a health care agent under
chapter 145C prevails over a designation made under this paragraph. The unrelated person may
also be identified as such by the patient or by the patient's family.
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
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.
Subd. 30. Protection and advocacy services.
Patients and residents shall have the right of
reasonable access at reasonable times to any available rights protection services and advocacy
services so that the patient may receive assistance in understanding, exercising, and protecting
the rights described in this section and in other law. This right shall include the opportunity for
private communication between the patient and a representative of the rights protection service
or advocacy service.
Subd. 31. Isolation and restraints.
A minor patient who has been admitted to a residential
program as defined in section
has the right to be free from physical restraint and isolation
except in emergency situations involving a likelihood that the patient will physically harm the
patient's self or others. These procedures may not be used for disciplinary purposes, to enforce
program rules, or for the convenience of staff. Isolation or restraint may be used only upon the
prior authorization of a physician, psychiatrist, or licensed psychologist, only when less restrictive
measures are ineffective or not feasible and only for the shortest time necessary.
Subd. 32. Treatment plan.
A minor patient who has been admitted to a residential program
as defined in section
has the right to a written treatment plan that describes in behavioral
terms the case problems, the precise goals of the plan, and the procedures that will be utilized to
minimize the length of time that the minor requires inpatient treatment. The plan shall also state
goals for release to a less restrictive facility and follow-up treatment measures and services, if
appropriate. To the degree possible, the minor patient and the minor patient's parents or guardian
shall be involved in the development of the treatment and discharge plan.
Subd. 33. Restraints.
(a) Competent nursing home residents, family members of residents
who are not competent, and legally appointed conservators, guardians, and health care agents
as defined under section
, have the right to request and consent to the use of a physical
restraint in order to treat the medical symptoms of the resident.
(b) Upon receiving a request for a physical restraint, a nursing home shall inform the
resident, family member, or legal representative of alternatives to and the risks involved with
physical restraint use. The nursing home shall provide a physical restraint to a resident only upon
receipt of a signed consent form authorizing restraint use and a written order from the attending
physician that contains statements and determinations regarding medical symptoms and specifies
the circumstances under which restraints are to be used.
(c) A nursing home providing a restraint under paragraph (b) must:
(1) document that the procedures outlined in that paragraph have been followed;
(2) monitor the use of the restraint by the resident; and
(3) periodically, in consultation with the resident, the family, and the attending physician,
reevaluate the resident's need for the restraint.
(d) A nursing home shall not be subject to fines, civil money penalties, or other state or
federal survey enforcement remedies solely as the result of allowing the use of a physical restraint
as authorized in this subdivision. Nothing in this subdivision shall preclude the commissioner
from taking action to protect the health and safety of a resident if:
(1) the use of the restraint has jeopardized the health and safety of the resident; and
(2) the nursing home failed to take reasonable measures to protect the health and safety
of the resident.
(e) For purposes of this subdivision, "medical symptoms" include:
(1) a concern for the physical safety of the resident; and
(2) physical or psychological needs expressed by a resident. A resident's fear of falling may
be the basis of a medical symptom.
A written order from the attending physician that contains statements and determinations regarding
medical symptoms is sufficient evidence of the medical necessity of the physical restraint.
(f) When determining nursing facility compliance with state and federal standards for the use
of physical restraints, the commissioner of health is bound by the statements and determinations
contained in the attending physician's order regarding medical symptoms. For purposes of this
order, "medical symptoms" include the request by a competent resident, family member of a
resident who is not competent, or legally appointed conservator, guardian, or health care agent as
defined under section
, that the facility provide a physical restraint in order to enhance
the physical safety of the resident.
History: 1973 c 688 s 1; 1976 c 274 s 1; 1982 c 504 s 1; 1983 c 248 s 1; 1984 c 654 art 5 s
8; 1984 c 657 s 1; 1986 c 326 s 1-6; 1986 c 444; 1989 c 186 s 1; 1989 c 282 art 3 s 5; 1991 c 255
s 19; 1993 c 54 s 1-3; 1995 c 136 s 3,4; 1995 c 189 s 8; 1995 c 229 art 4 s 5,6; 1996 c 277 s 1;
1998 c 254 art 2 s 10; 1999 c 83 s 1; 2004 c 198 s 10; 2007 c 147 art 9 s 18-20; art 10 s 15