[Code of Federal Regulations]
[Title 38, Volume 1]
[Revised as of January 1, 2007]
From the U.S. Government Printing Office via GPO Access
[CITE: 38CFR17.33]

[Page 632-635]
 
            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.

[[Page 633]]

    (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 paragraphs (c) and (d) 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.
    (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.

[[Page 634]]

    (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 care 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 
detailing the indications therefor are both entered into the patient's 
permanent medical record.
    (2) For the purpose of paragraph (c) of this section, a valid and 
sufficient reason exists when, after consideration of pertinent facts, 
including the patient's history, current condition and prognosis, a 
health care 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 care 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 (b) 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 
under paragraph (c) of this section and the reasons therefor.
    (5) All restricting orders under paragraph (c) of this section 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 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 an appropriate licensed health 
care professional. 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, but 
in such an event, an appropriate licensed health care professional must 
examine the patient and sign a written order within an appropriate 
timeframe that is in compliance with current community and/or 
accreditation standards. In emergency situations, where inability to 
contact an appropriate licensed health care professional 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 an 
appropriate licensed health care professional . Use of restraints or 
seclusion may continue for a period of time that does not exceed current 
community and/or accreditation standards, within which time an 
appropriate licensed health care professional shall again be consulted 
to determine if continuance of such restraint or seclusion is required. 
Restraint or seclusion may not be used as

[[Page 635]]

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 within 
appropriate timeframes in compliance with current community and/or 
accreditation standards:
    (i) By an appropriate health care professional who will monitor and 
chart the patient's physical and mental condition; and
    (ii) By other ward personnel as frequently as is reasonable under 
existing circumstances.
    (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 a written order of an appropriate health care 
professional in that patient's medical record. The written order may be 
entered on the basis of telephonic authority received from an 
appropriate health care professional, but in such event, the written 
order must be countersigned by an appropriate health care professional 
within 24 hours of the ordering of the medication. An appropriate health 
care professional will be responsible for all medication given or 
administered to a patient. A review by an appropriate health care 
professional of the drug regimen of each inpatient shall take place 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, 
as amended at 70 FR 67094, Nov. 4, 2005]

                  Tentative Eligibility Determinations