[Code of Federal Regulations]
[Title 38, Volume 1]
[Revised as of July 1, 2002]
From the U.S. Government Printing Office via GPO Access
[CITE: 38CFR17.33]

[Page 582-585]
 
            TITLE 38--PENSIONS, BONUSES, AND VETERANS' RELIEF
 
                CHAPTER I--DEPARTMENT OF VETERANS AFFAIRS
 
PART 17--MEDICAL--Table of Contents
 
Sec. 17.33  Patients' rights.

    (a) General. (1) Patients have a right to be treated with dignity in 
a humane environment that affords them both reasonable protection from 
harm and appropriate privacy with regard to their personal needs.
    (2) Patients have a right to receive, to the extent of eligibility 
therefor under the law, prompt and appropriate treatment for any 
physical or emotional disability.
    (3) Patients have the right to the least restrictive conditions 
necessary to achieve treatment purposes.
    (4) No patient in the Department of Veterans Affairs medical care 
system, except as otherwise provided by the applicable State law, shall 
be denied legal rights solely by virtue of being voluntarily admitted or 
involuntarily committed. Such legal rights include, but are not limited 
to, the following:
    (i) The right to hold and to dispose of property except as may be 
limited in accordance with paragraph (c)(2) of this section;
    (ii) The right to execute legal instruments (e.g., will);
    (iii) The right to enter into contractual relationships;
    (iv) The right to register and vote;
    (v) The right to marry and to obtain a separation, divorce, or 
annulment;
    (vi) The right to hold a professional, occupational, or vehicle 
operator's license.
    (b) Residents and inpatients. Subject to paragraph (c) of this 
section, patients admitted on a residential or inpatient care basis to 
the Department of Veterans Affairs medical care system have the 
following rights:
    (1) Visitations and communications. Each patient has the right to 
communicate freely and privately with persons outside the facility, 
including government officials, attorneys, and clergymen. To facilitate 
these communications each patient shall be provided the opportunity to 
meet with visitors during regularly scheduled visiting hours, convenient 
and reasonable access to public telephones for making and receiving 
phone calls, and the opportunity to send and receive unopened mail.
    (i) Communications with attorneys, law enforcement agencies, or 
government officials and representatives of recognized service 
organizations when the latter are acting as agents for the patient in a 
matter concerning Department of Veterans Affairs benfits, shall not be 
reviewed.
    (ii) A patient may refuse visitors.
    (iii) If a patient's right to receive unopened mail is restricted 
pursuant to paragraph (c) of this section, the patient shall be required 
to open the sealed mail while in the presence of an appropriate person 
for the sole purpose of ascertaining whether the mail contains 
contraband material, i.e., implements which pose significant risk of 
bodily harm to the patient or others or any drugs or medication. Any 
such material will be held for the patient or disposed of in accordance 
with instructions concerning patients' mail published by the Veterans 
Health Administration, Department of Veterans Affairs, and/or the local 
health care facility.
    (iv) Each patient shall be afforded the opportunity to purchase, at 
the patient's expense, letter writing material including stamps. In the 
event a patient needs assistance in purchasing writing material, or in 
writing, reading or sending mail, the medical facility will attempt, at 
the patient's request, to provide such assistance by means of 
volunteers, sufficient to mail at least one (1) letter each week.

[[Page 583]]

    (v) All information gained by staff personnel of a medical facility 
during the course of assisting a patient in writing, reading, or sending 
mail is to be kept strictly confidential except for any disclosure 
required by law.
    (2) Clothing. Each patient has the right to wear his or her own 
clothing.
    (3) Personal Possessions. Each patient has the right to keep and use 
his or her own personal possessions consistent with available space, 
governing fire safety regulations, restrictions on noise, and 
restrictions on possession of contraband material, drugs and 
medications.
    (4) Money. Each patient has the right to keep and spend his or her 
own money and to have access to funds in his or her account in 
accordance with instructions concerning personal funds of patients 
published by the Veterans Health Administration.
    (5) Social Interaction. Each patient has the right to social 
interaction with others.
    (6) Exercise. Each patient has the right to regular physical 
exercise and to be outdoors at regular and frequent intervals. 
Facilities and equipment for such exercise shall be provided.
    (7) Worship. The opportunity for religious worship shall be made 
available to each patient who desires such opportunity. No patient will 
be coerced into engaging in any religious activities against his or her 
desires.
    (c) Restrictions. (1) A right set forth in paragraph (b) of this 
section may be restricted within the patient's treatment plan by written 
order signed by the appropriate health or mental health professional if-
-
    (i) It is determined pursuant to paragraph (c)(2) of this section 
that a valid and sufficient reason exists for a restriction, and
    (ii) The order imposing the restriction and a progress note 
detaining the indications therefor are both entered into the patient's 
permanent medical record.
    (2) For the purpose of this paragraph, a valid and sufficient reason 
exists when, after consideration of pertinent facts, including the 
patient's history, current condition and prognosis, a health or mental 
health professional reasonably believes that the full exercise of the 
specific right would--
    (i) Adversely affect the patient's physical or mental health,
    (ii) Under prevailing community standards, likely stigmatize the 
patient's reputation to a degree that would adversely affect the 
patient's return to independent living,
    (iii) Significantly infringe upon the rights of or jeopardize the 
health or safety of others, or
    (iv) Have a significant adverse impact on the operation of the 
medical facility, to such an extent that the patient's exercise of the 
specific right should be restricted. In determining whether a patient's 
specific right should be restricted, the health or mental health 
professional concerned must determine that the likelihood and 
seriousness of the consequences that are expected to result from the 
full exercise of the right are so compelling as to warrant the 
restriction. The Chief of Service or Chief of Staff, as designated by 
local policy, should concur with the decision to impose such 
restriction. In this connection, it should be noted that there is no 
intention to imply that each of the reasons specified in paragraphs 
(c)(2)(i) through (iv) of this section are logically relevant to each of 
the rights set forth in paragraph (b)(1) of this section.
    (3) If it has been determined under paragraph (c)(2) of this section 
that a valid and sufficient reason exists for restricting any of the 
patient's rights set forth in paragraph (c)(1) of this section, the 
least restrictive method for protecting the interest or interests 
specified in paragraphs (c)(2)(i) through (iv) of this section that are 
involved shall be employed.
    (4) The patient must be promptly notified of any restriction imposed 
pursuant to this paragraph and the reasons therefor.
    (5) All restricting orders must be reviewed at least once every 30 
days by the practitioner and must be concurred in by the Chief of 
Service or Chief of Staff.
    (d) Restraint and seclusion of patients. (1) Each patient has the 
right to be free from physical restraint or seclusion except in 
situations in which there is a substantial risk of imminent harm by

[[Page 584]]

the patient to himself, herself, or others and less restrictive means of 
preventing such harm have been determined to be inappropriate or 
insufficient. Patients will be physically restrained or placed in 
seclusion only on the written order of a physician. The reason for any 
restraint order will be clearly documented in the progress notes of the 
patient's medical record. The written order may be entered on the basis 
of telephonic authority received from a physician, but in such an event 
the ordering physician must examine the patient and sign the written 
order within twelve (12) hours of giving the order for restraint or 
seclusion. In emergency situations, where inability to contact a 
physician prior to restraint is likely to result in immediate harm to 
the patient or others, the patient may be temporarily restrained by a 
member of the staff until appropriate authorization can be received from 
a physician. Use of restraints or seclusion shall be for no more than 
twenty-four (24) hours, at which time the physician shall again be 
consulted to determine if continuance of such restraint or seclusion is 
required. Restraint or seclusion may not be used as a punishment, for 
the convenience of staff, or as a substitute for treatment programs.
    (2) While in restraint or seclusion, the patient must be seen at 
least once every twelve (12) hours by an appropriate health professional 
who will monitor and chart the patient's physical and mental condition 
and by other ward personnel as frequently as is reasonable under 
existing circumstances, but no less than once each hour.
    (3) Each patient in restraint or seclusion shall have bathroom 
privileges according to his or her needs.
    (4) Each patient in restraint or seclusion shall have the 
opportunity to bathe at least every twenty-four (24) hours.
    (5) Each patient in restraint or seclusion shall be provided 
nutrition and fluid appropriately.
    (e) Medication. Patients have a right to be free from unnecessary or 
excessive medication. Except in an emergency, medication will be 
administered only on the written order of a physician in that patient's 
medical record. The written order may be entered on the basis of 
telephonic authority received from a physician, but in such event a 
physician must countersign the written order within 24 hours of the 
ordering of the medication. The attending physician shall be responsible 
for all medication given or administered to a patient. The attending 
physician shall review the drug regimen of each patient under his or her 
care at least every thirty (30) days. It is recognized that 
administration of certain medications will be reviewed more frequently. 
Medication shall not be used as punishment, for the convenience of the 
staff, or in quantities which interfere with the patient's treatment 
program.
    (f) Confidentiality. Information gained by staff from the patient or 
the patient's medical record will be kept confidential and will not be 
disclosed except in accordance with applicable law.
    (g) Patient grievances. Each patient has the right to present 
grievances with respect to perceived infringement of the rights 
described in this section or concerning any other matter on behalf of 
himself, herself or others, to staff members at the facility in which 
the patient is receiving care, other Department of Veterans Affairs 
officials, government officials, members of Congress or any other person 
without fear or reprisal.
    (h) Notice of patient's rights. Upon the admission of any patient, 
the patient or his/her representative shall be informed of the rights 
described in this section, shall be given a copy of a statement of those 
rights and shall be informed of the fact that the statement of rights is 
posted at each nursing station. All staff members assigned to work with 
patients will be given a copy of the statement of rights and these 
rights will be discussed with them by their immediate supervisor.
    (i) Other rights. The rights described in this section are in 
addition to and not in derogation of any statutory, constitutional or 
other legal rights.

(Authority: 38 U.S.C. 501, 1721)

[47 FR 55486, Dec. 10, 1982. Redesignated at 61 FR 21965, May 13, 1996]

[[Page 585]]

                  Tentative Eligibility Determinations