Treatment

(1) Informed Consent, Consent to Treatment. (a) Upon admission to a facility a patient shall, upon giving informed consent, receive treatment and rehabilitation when ordered in accordance with accepted therapeutic practice. (b) Prior to an adjudication of incapacity or invocation and affirmation of a health care proxy, a patient retains the right to accept or refuse treatment. (c) Informed consent must be documented in the patient’s medical record. (d) Extraordinary treatment, as defined by statute or case law including, but not limited to, treatment with antipsychotic medication, may not be administered or performed without the patient’s specific informed consent. In the case of a patient who lacks capacity to give informed consent, such treatment may not be administered or performed without prior review and approval by a court of competent jurisdiction or in the case of a minor or a patient with a properly invoked healthcare proxy, the consent of his or her legally authorized representative. (e) For a patient who is believed to lack capacity to give informed consent to treatment with antipsychotic medication, and who is not being treated pursuant to consent by the parent of a minor or by a health care agent pursuant to a properly invoked and affirmed health care proxy, the right to refuse such medication may be overridden prior to an adjudication of incapacity and court approval of a treatment plan only in rare circumstances to prevent an immediate, substantial and irreversible deterioration of the patient’s mental illness. If treatment is to be continued over the patient’s objection, and the patient continues to lack capacity, then an adjudication of incapacity and court approval of a treatment plan must be sought. (2) Electroconvulsive Treatment for Patients Younger than 16 Years Old. (a) Electroconvulsive treatment shall not be administered to any patient younger than 16 years old, unless the Commissioner or designee concurs. (b) The approval of the administration of electroconvulsive treatments to patients younger than 16 years old shall be based on such written recommendations and independent consultations as the Commissioner or designee deems appropriate under the circumstances of the individual case. (c) The Commissioner or designee’s approval, and the basis therefore, shall become a permanent part of the patient’s record. (3) Routine and Preventive Treatment. A patient shall be informed upon admission and at each periodic review of the routine and preventive treatment that is ordinarily performed at, or arranged by, the facility. Routine and preventive treatment includes standard medical examinations, clinical tests, standard immunizations, and treatment for minor illnesses and injuries. A patient who has capacity to give informed consent regarding routine and preventive treatment may accept or refuse such treatment, except that a refusal may be overridden by the facility director, without special court authorization, when the treatment consists of: (a) a complete physical examination, and associated routine laboratory tests, required by law to be conducted upon admission and at least annually thereafter. (b) immunizations or treatment required by law or necessary to prevent the spread of infection or disease. (4) Written Treatment Plan. (a) The patient has the right to participate in the development and implementation of his or her treatment plan. (b) As part of the treatment of a patient in a facility, there shall be a written assessment of the strengths and needs of the patient and a written, multi-disciplinary treatment plan, which shall be developed with the maximum possible participation of the patient or the patient’s legally authorized representative. (c) The treatment plan, upon acceptance by the patient or his or her legally authorized representative, shall be implemented by the facility staff in good faith within the limits of available resources. (d) There shall be a periodic written assessment of treatment progress. Modifications of the treatment plan and the rationale for such modifications shall be documented in the patient’s record. (5) Additional Requirements for Patients Eligible for Public School Education. (a) Treatment plans for patients who are “children with special needs”, as defined in M.G.L. c. 71B shall, where appropriate, take into account the plan for providing special education services developed in accordance with 603 CMR: Department of Elementary and Secondary Education. (b) Treatment plans for patients who are eligible for public school education but who are not “children with special needs” as defined in M.G.L. c. 71B, § 1, shall, if appropriate, and in addition to all other requirements for treatment plans, reflect such patient’s educational needs.