The Importance of Client Rights
The Importance of Client Rights Denise Eberhart
Client Rights and Confidentiality Instructor: Jerry Van Kirk October 1, 2011 Abstract This reflection paper discusses various client rights, especially in regard to inpatient treatment facilities. It discusses the importance of client rights to protect, lawfully, these human beings. The counselor plays a significant role of informing the client of their rights, using the guidelines set forth by the Wisconsin Administrative code and the Wisconsin State statutes as well as the NAADAC Code of Ethics. Informed consents will also be discussed. Understanding and adhering to client rights are of utmost importance in the field of counseling because patients, in most cases, are especially vulnerable. Patients come to us for help and probably lack basic coping skills. They may also lack knowledge about their rights. It is part of our job to insure their safety. In doing so, we must be sure their rights are presented, explained and respected. The patient must be treated using the client rights set forth in the Wisconsin Administration codes and the Wisconsin Statues. Wisconsin statute 51.20 deals with client rights in general and Chapter 51 deals with the rights of individuals that may be committed against their will. The DHS administrative code 94 deals with patient rights and grievances. These can be accessed whenever a question of client right’s arises. As counselors we need to be familiar with these, as well as the Code of Ethics (NAADAC) to guide our behavior as therapist. Lack of doing so could result in harm to the client and set oneself up for malpractice.
Any individual who is receiving services for mental illness, developmental disabilities, alcoholism or drug dependency, including any individual who is admitted to a treatment facility will upon admission or commitment be informed orally and in writing of his or her rights. (Wisconsin Department of Health Services, 2011) Treatment rights include that the individual is allowed to participate in his/her treatment planning and be informed of treatment and care. Clients can refuse treatment and medications unless court ordered. The client has the right to be free of unnecessary medications. There are rights of records pertaining to the client which include-privacy (confidentiality) and access to these records. A patient’s information is confidential and releases of information must be signed by the patient before information can be discussed with anyone else. There may be some exceptions to this; however, it is my experience that this can be very questionable. The client may see records of the therapist’s notes and any information about medication and health treatment. Access to these records can only be limited if the risks outweigh the benefit. Again, this is a judgment call and for the most part a client has the right to see his records. Clients may challenge the accuracy and completeness, timeliness or relevance of entries in their records.
In the cases of inpatient treatment, there are certain rights of communication including reasonable access to the phone. Visitors must be allowed, but, the patient may also refuse such visits. Patients in a facility must be allowed to send and receive mail as well as allowed to contact public officials/lawyers and patient advocates. The client has personal rights which include the least restrictive environment where they are not secluded or restrained, except in emergency situations. They can wear their own clothing and use their own possessions. The client must be offered regular frequent physical activity and have access to spend time outdoor. The staff can make reasonable (non arbitrary) decisions about the client. The client can also refuse to work beyond personal housekeeping tasks.
Privacy rights include not being filmed or taped without consent, having personal toilet and bathing facilities as well as reasonable storage space for personal belongings. Lastly, there are miscellaneous rights that include being treated with dignity and respect by all staff members. The client can refuse ECT therapy (electroconvulsive therapy) and refuse drastic treatment measures. The client has the right to file a complaint about any violation of his or her rights and be free of retribution for filing the claim. (DHS 94.03, 2011) The client needs to be informed of these rights and of any cost of care.
Under the Wisconsin Administrative Code (DHS 94.02) an “Informed consent” means a written consent voluntarily signed by a patient who is competent and who understands the terms of the consent. This consent includes specific, complete, accurate information and the client is given time to study the information or seek additional information concerning treatment or services directly related to the person’s mental illness, developmental disability, alcoholism or drug dependency. This consent needs to include the benefits of the proposed treatment and services, the way the treatment is administered and the services provided. It should further provide alternative treatment modes and services. It should also include 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 (DHS 94.03, 2011) The client has the right to withdraw the informed consent at any time, in writing. Verbal consent is valid for a period of 10 days during which time the informed consent needs to be obtained in writing. (DHS 94.03, 2011) The patient (or the person acting on the patient’s behalf) will be given a copy of the completed informed consent. If an informed consent is refused or withdrawn, no retaliation may be threatened or carried out. This is the counselor’s duty to explain to the client and is suggested to be done as soon after initial contact is made. In the setting of a counseling session that doesn’t involve commitment, the counselor is still expected to explain the confidentiality limitations, record keeping, expectation of treatment for both parties , termination of treatment procedures, diagnosis’s, costs, etc. and obtain permission from the clients.
If the codes and statutes are followed, as well as the NAADAC Code of Ethics, “the therapist should do no harm to the client and also protect themselves from malpractice suits” (Supervisors: Legal and Ethical Issues, 2009) Failure to obtain an informed consent could be a means for a client to pursue a malpractice suit. Record keeping is very important and should include identifying data, fees and billing information, documentation of informed consent and waivers of confidentiality. Progress notes should present current problems and diagnosis and a treatment plan for services. (Gerald Cory, 2011) Also the counselor should note behaviors and reactions of the client to assessments and session discussion.
In the field of substance abuse counseling (or any other client/professional relationship) it is fundamentally important to protect the client. The WI State Statutes, the administrative codes and the Code of Ethics (NAADAC) are designed to protect the clients from abuse or unnecessary treatment. Following these guidelines also protects the counselors from bogus lawsuits brought about by angry or ill clients. The primary purpose is to provide high quality service. Good record keeping, including an informed consent proves that adequate care was provided, which would be questioned if a disciplinary hearing were to take place (Welfel, 2010) From an ethical, legal and clinical perspective, it is an important responsibility to know and understand the client’s rights. Clients need to be respected and counselors need to be sure to do no harm by their own behavior or lack of knowledge of client rights. References
(2011, March). Retrieved September 25, 2011, from Wisconsin Department of Health Services: http://www.dhs.wisconsin.gov/clientrights
DHS 94.03. (2011, August 31). Retrieved September 25, 2011, from current through 2011 Wisconsin Act 44: http://docs.legis.wisonsin.gov/statutes/statutes/51.pdf
Gerald Cory, M. S. (2011). Issues and Ethics in the Helping Professions. Belmont: Brookes/Cole Cengage Learning.
Supervisors: Legal and Ethical Issues. (2009, March). Retrieved Sept 29, 2011, from Samhsa: http://Kap/Samhsa.gov/products/manuals/tips/pdf/TIP52-LitRev.pdf
Welfel, E. (2010). Ethics in counseling and psycholtherapy: standards,research and emerging issues 4th edition. Belmont: Brookes/Cole, Cenage learning.