Chapter DHS 94

DHS 94.01(2)(b) (b) Subchapter III does not apply to the grievance procedures of the state mental health institutes, the state centers for persons with developmental disabilities or units housing patients committed under ch. 980, Stats., nor does it apply to individual private practitioners who deliver services through offices that are not part of a program.

DHS 94.01 History History: Cr. Register, January, 1987, No. 373, eff. 2-1-87; correction in (2) made under s. 13.93 (2m) (b) 7., Stats., Register, June, 1995, No. 474; am. (1), renum. (2) to be (2) (a) and am., cr. (2) (b), Register, June, 1996, No. 486, eff. 7-1-96; corrections in (2) made under s. 13.92 (4) (b) 7., Stats., Register November 2008 No. 635.

DHS 94.02 DHS 94.02 Definitions. In this chapter:

DHS 94.02(1) (1) “Body cavity search” means a strip search in which body cavities are inspected by the entry of an object or fingers into body cavities.

DHS 94.02(2) (2) “Body search” means a personal search, a strip search or a body cavity search of a patient.

DHS 94.02(3) (3) “Client,” as used in subch. III, means a patient.

DHS 94.02(4) (4) “Client rights specialist” means a person designated by a program or a coalition of programs to facilitate informal resolution of concerns where requested and to conduct program level reviews of grievances and make proposed factual findings, determinations of merit and recommendations for resolution which are provided to the program manager and the client.

DHS 94.02(5) (5) “Coalition of programs,” as used in subch. III, means a group of programs which have joined together for the explicit purpose of operating a combined grievance resolution system.

DHS 94.02(6) (6) “Community placement” means a living situation which is arranged with the assistance of a case manager or service coordinator or a person or agency performing tasks similar to those performed by a case manager or service coordinator and which is either a residential setting that is directed and controlled by the individual or his or her guardian or a place licensed or certified as a residential care facility or care home for either adults or children by representatives of the state or county government pursuant to a comprehensive individualized plan of care or service.

DHS 94.02(7) (7) “Concern” means a complaint, disagreement or dispute which a client or a person on behalf of a client may have with a program or program staff which the client chooses to resolve through the informal resolution process pursuant to s. DHS 94.40 (4).

DHS 94.02(8) (8) “County department” means the county department of human services established under s. 46.23, Stats., the county department of community programs established under s. 51.42, Stats., or the county department of developmental disabilities services established under s. 51.437, Stats.

DHS 94.02(9) (9) “Court order” means a lawful order of a court of competent jurisdiction.

DHS 94.02(10) (10) “Department” means the Wisconsin department of health services.

DHS 94.02(11) (11) “Director” means the administrator of a treatment facility or the person directing the activities of any other service provider.

DHS 94.02(12) (12) “Drastic treatment procedure” means an extraordinary or last resort treatment method which places the patient at serious risk for permanent psychological or physical injury, including psychosurgery, convulsive therapy other than electroconvulsive therapy and behavior modification using painful stimuli.

DHS 94.02(13) (13) “Emergency” means that it is likely that the patient may physically harm himself or herself or others.

DHS 94.02(14) (14) “Emergency situation” means a situation in which, based on the information available at the time, there is reasonable cause to believe that a client or a group of clients is at significant risk of physical or emotional harm due to the circumstances identified in a grievance or concern.

DHS 94.02(15) (15) “Financial benefit” means improvement in the functioning of a facility due to patient labor.

DHS 94.02(16) (16) “Forensic unit” means an inpatient ward or unit where a majority of the patients are admitted or committed under ch. 971 or 975, Stats., or under s. 51.37 (5), Stats.

DHS 94.02(17) (17) “Grievance” means a statement by a grievant that an action or an inaction by a program or its staff has abridged rights guaranteed to the client under s. 51.61, Stats., and this chapter combined with a request that the matter be dealt with through the program’s formal grievance resolution process pursuant to s. DHS 94.40 (5).

DHS 94.02(18) (18) “Grievance examiner” means a staff person of the department designated by the secretary to conduct first administrative level reviews of grievances appealed from programs operating independently from a county department and second administrative level reviews of grievances filed regarding programs operated by or under contract with a county department.

DHS 94.02(19) (19) “Grievance resolution system” means the procedures established by a program or coalition of programs for formally responding to a grievance.

DHS 94.02(20) (20) “Grievant” means a client who has lodged a grievance or a person who has lodged a grievance on behalf of a client pursuant to s. DHS 94.49.

DHS 94.02(21) (21) “Hospital” has the meaning prescribed in s. 50.33 (2), Stats.

DHS 94.02(22) (22) “Informed consent” or “consent” means written consent voluntarily signed by a patient who is competent and who understands the terms of the consent, or by the patient’s legal guardian or the parent of a minor, as permitted under s. 51.61 (6) and (8), Stats., without any form of coercion, or temporary oral consent obtained by telephone in accordance with s. DHS 94.03 (2m).

DHS 94.02(23) (23) “Inpatient” means a person who is receiving treatment, care, services or supports while residing in an inpatient treatment facility, a residential treatment facility or in any facility or home which is subject to regulation as a place of residence and service provision for patients by the department, a county department or a county department of social services established under s. 46.215 or 46.22, Stats.

DHS 94.02(24) (24) “Inpatient treatment facility” has the meaning prescribed for “inpatient facility” in s. 51.01 (10), Stats., and includes the mental health institutes as defined in s. 51.01 (12), Stats., the Milwaukee county mental health center established under s. 51.08, Stats., and county hospitals established under s. 51.09, Stats.

DHS 94.02(25) (25) “Institutional review board” means a board established under 45 CFR 46.

DHS 94.02(26) (26) “Isolation” means any process by which a person is physically or socially set apart by staff from others but does not include separation for the purpose of controlling contagious disease.

DHS 94.02(27) (27) “Least restrictive treatment” means treatment and services which will best meet the patient’s treatment and security needs and which least limit the patient’s freedom of choice and mobility.

DHS 94.02(28) (28) “Mechanical support” means an apparatus that is used to properly align a patient’s body or to help a patient maintain his or her balance.

DHS 94.02(29) (29) “Medical restraint” means an apparatus or procedure that restricts the free movement of a patient during a medical or surgical procedure or prior to or subsequent to such a procedure to prevent further harm to the patient or to aid in the patient’s recovery, or to protect a patient during the time a medical condition exists.

DHS 94.02(30) (30) “Outpatient” means a person receiving treatment, care, services or supports from any service provider if the person receiving the services does not reside in a facility or home owned, operated or managed by the service provider.

DHS 94.02(31) (31) “Outpatient treatment facility” means a service provider providing services for patients who do not reside in a facility or home owned, operated or managed by the service provider.

DHS 94.02(32) (32) “Patient” has the meaning prescribed in s. 51.61 (1) (intro.), Stats.

DHS 94.02(33) (33) “Personal search” means a search of the patient’s person, including the patient’s pockets, frisking his or her body, an examination of the patient’s shoes and hat and a visual inspection of the patient’s mouth.

DHS 94.02(34) (34) “Physical restraint” means any physical hold or apparatus, excluding a medical restraint or mechanical support, that interferes with the free movement of a person’s limbs and body.

DHS 94.02(35) (35) “Program,” as used in subch. III, means any public or private organization or agency, other than Mendota and Winnebago mental health institutes, the state centers for persons with developmental disabilities and the Wisconsin resource center, which provides services or residential care for a client for mental illness, a developmental disability, alcoholism or drug dependency.

DHS 94.02(36) (36) “Program director” means the person appointed to administer the county department’s programs.

DHS 94.02(37) (37) “Program manager,” as used in subch. III, refers to the individual in charge of the operation of a program who has the specific authority to approve and implement decisions made through the grievance resolution process.

DHS 94.02(38) (38) “Research” means a systematic investigation designed to develop or contribute to generalizable knowledge, except that it does not include an investigation involving only treatment records or routine follow-up questionnaires.

DHS 94.02(39) (39) “Residential treatment facility” means a treatment facility or home that provides a 24-hour residential living program and services for inpatients, which is subject to regulation as a place of residence and services for patients by the department or any county department or a county department of social services under s. 46.215 or 46.22, Stats., including a center for the developmentally disabled as defined in s. 51.01 (3), Stats.

DHS 94.02(40) (40) “Seclusion” means that form of isolation in which a person is physically set apart by staff from others through the use of locked doors.

DHS 94.02(41) (41) “Secretary” means the head of the department.

DHS 94.02(42) (42) “Service provider” means an agency, facility or individual providing treatment, care, services or supports to clients.

DHS 94.02(43) (43) “Strip search” means a search in which the patient is required to remove all of his or her clothing. Permissible inspection includes examination of the patient’s clothing and body and visual inspection of his or her body cavities.

DHS 94.02(44) (44) “Treatment” has the meaning prescribed in s. 51.01 (17), Stats.

DHS 94.02(45) (45) “Treatment facility” means any publicly or privately operated facility, unit in a facility or agency providing treatment, habilitation or rehabilitation for alcoholic, drug dependent, mentally ill or developmentally disabled persons, including an inpatient treatment facility, a residential treatment facility or an outpatient treatment facility.

DHS 94.02 History History: Cr. Register, January, 1987, No. 373, eff. 2-1-87; r. and recr. Register, June, 1996, No. 486, eff. 7-1-96; correction in (8) made under s. 13.93 (2m) (b) 7., Stats., Register January 2002 No. 553; correction in (10) made under s. 13.92 (4) (b) 6., Stats., Register November 2008 No. 635.

DHS 94.03 DHS 94.03 Informed consent.

DHS 94.03(1) (1) Any informed consent document required under this chapter shall declare that the patient or the person acting on the patient’s behalf has been provided with specific, complete and accurate information and time to study the information or to seek additional information concerning the proposed treatment or services made necessary by and directly related to the person’s mental illness, developmental disability, alcoholism or drug dependency, including:

DHS 94.03(1)(a) (a) The benefits of the proposed treatment and services;

DHS 94.03(1)(b) (b) The way the treatment is to be administered and the services are to be provided;

DHS 94.03(1)(c) (c) The expected treatment side effects or risks of side effects which are a reasonable possibility, including side effects or risks of side effects from medications;

DHS 94.03(1)(d) (d) Alternative treatment modes and services;

DHS 94.03(1)(e) (e) The probable consequences of not receiving the proposed treatment and services;

DHS 94.03(1)(f) (f) The time period for which the informed consent is effective, which shall be no longer than 15 months from the time the consent is given; and

DHS 94.03(1)(g) (g) The right to withdraw informed consent at any time, in writing.

DHS 94.03(2) (2) An informed consent document is not valid unless the subject patient who has signed it is competent, that is, is substantially able to understand all significant information which has been explained in easily understandable language, or the consent form has been signed by the legal guardian of an incompetent patient or the parent of a minor, except that the patient’s informed consent is always required for the patient’s participation in experimental research, subjection to drastic treatment procedures or receipt of electroconvulsive therapy.

DHS 94.03(2m) (2m) In emergency situations or where time and distance requirements preclude obtaining written consent before beginning treatment and a determination is made that harm will come to the patient if treatment is not initiated before written consent is obtained, informed consent for treatment may be temporarily obtained by telephone from the parent of a minor patient or the guardian of a patient. Oral consent shall be documented in the patient’s record, along with details of the information verbally explained to the parent or guardian about the proposed treatment. Verbal consent shall be valid for a period of 10 days, during which time informed consent shall be obtained in writing.

DHS 94.03(3) (3) The patient, or the person acting on the patient’s behalf, shall be given a copy of the completed informed consent form, upon request.

DHS 94.03(4) (4) When informed consent is refused or withdrawn, no retaliation may be threatened or carried out.

DHS 94.03 Note Note: Additional requirements relating to refusal to participate in prescribed treatment are addressed under s. DHS 94.09.

DHS 94.03 History History: Cr. Register, January, 1987, No. 373, eff. 2-1-87; am. (1) (intro.), (a), (b), (d), (e), (f), cr. (2m), Register, June, 1996, No. 486, eff. 7-1-96.

DHS 94.04 DHS 94.04 Notification of rights.

DHS 94.04(1) (1) Before or upon admission or, in the case of an outpatient, before treatment is begun, the patient shall be notified orally and given a written copy of his or her rights in accordance with s. 51.61 (1) (a), Stats., and this chapter. Oral notification may be accomplished by showing the patient a video about patient rights under s. 51.61, Stats., and this chapter. The guardian of a patient who is incompetent and the parent of a minor patient shall also be notified, if they are available. Notification is not required before admission or treatment when there is an emergency.

DHS 94.04 Note Note: The statute does not make distinctions among types of treatment facilities when it comes to protecting patients’ rights. Some rights may be more applicable to patients in inpatient facilities than to patients in less restrictive facilities such as sheltered workshops or outpatient clinics. When informing patients of their rights, facility directors may emphasize those rights that are most applicable to the particular facility, program or services but s. 51.61, Stats., requires notification that other rights exist and may, under some circumstances, apply in a given situation.

DHS 94.04(2) (2) Before, upon or at a reasonable time after admission, a patient shall be informed in writing, as required by s. 51.61 (1) (w), Stats., of any liability that the patient or any of the patient’s relatives may have for the cost of the patient’s care and treatment and of the right to receive information about charges for care and treatment services.

DHS 94.04(3) (3) Patients who receive services for an extended period of time shall be orally re-notified of their rights at least annually and be given another copy of their rights in writing if they request a copy or if there has been a statutory change in any of their rights since the time of their admission.

DHS 94.04(4) (4) If a patient is unable to understand the notification of rights, written and oral notification shall be made to the parent or guardian, if available, at the time of the patient’s admission or, in the case of an outpatient, before treatment is begun, and to the patient when the patient is able to understand.

DHS 94.04(5) (5) All notification of rights, both oral and written, shall be in language understood by the patient, including sign language, foreign language or simplified language when that is necessary. A simplified, printed version of patients rights shall be conspicuously posted in each patient area.

DHS 94.04 Note Note: A simplified version of patient rights in poster form is available from the Division of Mental Health and Substance Abuse Services, P.O. Box 7851, Madison, WI 53707 or at www.dhs.wisconsin.gov/clientrights.

DHS 94.04 History History: Cr. Register, January, 1987, No. 373, eff. 2-1-87; am. (1), renum. (2), (3) to be (4), (5), cr. (2), (3), Register, June, 1996, No. 486, eff. 7-1-96.

subch. II of ch. DHS 94 Subchapter II — Patient Rights

DHS 94.05 DHS 94.05 Limitation or denial of rights.

DHS 94.05(1) (1) No patient right may be denied except as provided under s. 51.61 (2), Stats., and as otherwise specified in this chapter.

DHS 94.05(2) (2) 

DHS 94.05(2)(a) (a) Good cause for denial or limitation of a right exists only when the director or designee of the treatment facility has reason to believe the exercise of the right would create a security problem, adversely affect the patient’s treatment or seriously interfere with the rights or safety of others.

DHS 94.05(2)(b) (b) Denial of a right may only be made when there are documented reasons to believe there is not a less restrictive way of protecting the threatened security, treatment or management interests.

DHS 94.05(2)(c) (c) No right may be denied when a limitation can accomplish the stated purpose and no limitation may be more stringent than necessary to accomplish the purpose.

DHS 94.05(3) (3) At the time of the denial or limitation, written notice shall be provided to the patient and the guardian, if any, and a copy of that notice shall be placed in the patient’s treatment record. The written notice shall:

DHS 94.05(3)(a) (a) Inform the patient and the guardian, if any, of the right to an informal hearing or a meeting with the person who made the decision to limit or deny the right.

DHS 94.05(3)(b) (b) State the specific conditions required for restoring or granting the right at issue;

DHS 94.05(3)(c) (c) State the expected duration of denial or limitation; and

DHS 94.05(3)(d) (d) State the specific reason for the denial or limitation.

DHS 94.05(4) (4) Within 2 calendar days following the denial, written notice shall be sent as follows:

DHS 94.05(4)(a) (a) If the patient is a county department patient, to the county department’s client rights specialist and, in addition, if the patient is in a department-operated facility, to the department’s division of care and treatment facilities; and

DHS 94.05(4)(b) (b) If the patient is not a county department patient, to the treatment facility’s client rights specialist and, in addition, if the patient is in a department-operated facility, to the department’s division of care and treatment facilities.

DHS 94.05 Note Note: Copies of the rights-denial form may be requested from the Department’s website at www.dhs.wisconsin.gov/clientrights or by writing to the Division of Mental Health and Substance Abuse Services, P.O. Box 7851, Madison, WI 53707-7851.