Patients Who Lack Capacity To Give Or Withhold Informed Consent

WITH NO DECLARATION FOR MENTAL HEALTH TREATMENT. (1) If a patient’s actions, statements, and/or behavior indicate that they may lack capacity to give informed consent, a physician, licensed practitioner or other qualified mental health professional shall assess the patient’s capacity in accordance with the requirements of Rule Chapter 0940-01-06 (Capacity to Make Decisions). (2) A physician, licensed practitioner or qualified mental health professional who determines that a patient lacks capacity to give informed consent shall document the basis for the determination on a state-approved form in the patient’s medical record. (3) Psychotropic medication and/or physical treatment may be ordered for a patient who lacks capacity to give informed consent for up to seventy-two (72) hours and may be renewed once for up to seventy-two (72) additional hours if the patient continues to lack capacity to give informed consent. Further psychotropic medication and/or physical treatment requires authorization by the TRC. (4) Releases of information for a patient who lacks capacity to give informed consent shall be managed in accordance with applicable state and federal statutes and regulations until TRC authorization is obtained for releases of information. (5) By the end of the next regular working day following the determination that the patient lacks capacity to give informed consent, the PRA shall be informed. (6) The patient, the PRA, a member of the RMHI Medical Staff, or a member of the patient’s treatment team may request that the TRC make decision(s) for the patient regarding psychotropic medication, physical treatment, and/or release of information. PROCEDURES FOR PRESCRIPTION AND ADMINISTRATION OF CHAPTER 0940-01-02 PSYCHOTROPIC MEDICATIONS AT MENTAL HEALTH INSTITUTES (7) TRC Process If the patient, the PRA, a member of the RMHI Medical Staff, or a member of the patient’s treatment team requests the TRC to make a decision for the patient regarding psychotropic medication, physical treatment, and/or release of information, the TRC shall meet within three (3) regular working days of the request; and (a) Review the patient’s medical record, including the documentation relating to the patient lacking capacity, the need for psychotropic medication, physical treatment, and/or release of information, and the actions taken; (b) Interview the patient (unless the patient declines to participate in the TRC meeting); (c) Make the final decision regarding psychotropic medication, physical treatment, and/or release of information; and (d) Document the final decision on a state-approved form in the patient’s medical record. (8) The TRC shall authorize the release of information only for involuntary patients and may authorize the release of information only to qualified mental health professionals, other treatment agencies, providers, support persons or family members of the patient. (9) The PRA shall continue to monitor the patient at least every thirty (30) days and document comments and/or recommendations in the patient’s medical record. The PRA may, if indicated, request that a physician or qualified mental health professional reassess the patient to determine whether the patient still lacks capacity to give informed consent no more frequently than every two (2) weeks during the same admission. (10) If the patient gains capacity to give informed consent, the TRC’s authority expires, and informed consent must be obtained from the patient as required by Rules 0940-01-02-.04 and 0940-01-02-.06 before further administration of psychotropic medication, provision of physical treatment, and/or release of information. (11) If a patient continues to lack capacity for thirty (30) days, the PRA shall advise the Chief Executive Officer or designee of the need for a conservator to give informed consent for the patient. The Chief Executive Officer or designee shall proceed under authority of T.C.A. Title 33 to obtain a limited conservator for the patient. (a) If conservatorship proceedings are initiated within ninety (90) days after psychotropic medication, physical treatment, and/or release of information was authorized by the TRC, the psychotropic medication, physical treatment, and/or release of information may continue until a conservator is appointed or the patient gains capacity and provides informed consent. (b) If conservatorship proceedings are not initiated within ninety (90) days after psychotropic medication, physical treatment, and/or release of information was authorized by the TRC, the psychotropic medication, physical treatment, and/or release of information shall terminate no later than ninety (90) days after it was authorized by the TRC, and the patient shall not be medicated or treated and information shall not be released except in emergency situations under Rule 0940-01-02-.07 until a conservator is appointed or the patient no longer lacks capacity and gives informed consent.