Patients Who Do Not Lack Capacity And Withold Informed Consent

(1) Voluntary Patients (a) If a voluntary patient who does not lack capacity withholds informed consent for psychotropic medication, physical treatment, and/or release of information, the treatment team shall discuss the recommendations regarding the proposed psychotropic medication, physical treatment, and/or release of information and the patient’s response when informed consent is requested. (b) The treatment team shall attempt to formulate a plan that is acceptable to the patient (e.g., reduced dosage, alternate medication, a possible trial period of medication or treatment, alternative treatment if any is available, and/or a limited release of information), and shall then meet with the patient to determine if they are willing to give informed consent or authorization when applicable for the psychotropic medication, physical treatment, and/or release of information. (c) The treatment team shall document the following on a state-approved form in the patient’s medical record: 1. The discussion of the recommendations with the patient and the patient’s response; 2. The attempt to formulate a plan that is acceptable to the patient, including the patient’s involvement in this attempt, and the patient’s response; and 3. Any attempt to meet with the patient that the patient declines. (d) If, after the treatment team meets with the patient, the patient still withholds informed consent for the psychotropic medication or physical treatment, the psychotropic PROCEDURES FOR PRESCRIPTION AND ADMINISTRATION OF CHAPTER 0940-01-02 PSYCHOTROPIC MEDICATIONS AT MENTAL HEALTH INSTITUTES medication and/or physical treatment shall not be administered to the patient except in emergency situations as specified in Rule 0940-01-02-.07. (e) If, after the treatment team meets with the patient, the patient still withholds informed consent or authorization when applicable for release of information, releases of information shall be managed in accordance with applicable state and federal statutes and regulations. (f) Staff members may continue non-coercive efforts to persuade the patient to give informed consent for the psychotropic medication, physical treatment, and/or release of information. (2) Involuntary Patients (a) If an involuntary patient who does not lack capacity withholds informed consent for psychotropic medication, physical treatment, and/or release of information, the treatment team shall discuss the physician’s or licensed practitioner’s recommendations regarding the proposed psychotropic medication, physical treatment, and/or release of information and the patient’s response when informed consent is requested. (b) The treatment team shall attempt to formulate a plan that is acceptable to the patient (e.g., reduced dosage, alternate medication, a possible trial period of medication or treatment, alternative treatment if any is available, and/or a limited release of information), and shall then meet with the patient to determine if they are willing to give informed consent for the psychotropic medication, physical treatment, and/or release of information. (c) The treatment team shall document the following on a state-approved form in the patient’s medical record: 1. The discussion of the recommendations with the patient and the patient’s response; 2. The attempt to formulate a plan that is acceptable to the patient, including the patient’s involvement in this attempt, and the patient’s response; and 3. Any attempt to meet with the patient that the patient declines. (d) If, after the treatment team meets with the patient, the patient still withholds informed consent for the psychotropic medication and/or physical treatment and the treatment team continues to believe that the psychotropic medication and/or physical treatment is a necessary part of the patient’s treatment plan, a TRC meeting shall be requested. (e) If, after the treatment team meets with the patient, the patient still withholds informed consent for release of information, releases of information shall be managed in accordance with applicable state and federal statutes and regulations. The TRC shall not approve releases of information for a patient who does not lack capacity. (f) Staff members may continue non-coercive efforts to persuade the patient to give informed consent for the psychotropic medication, physical treatment, and/or release of information. (3) TRC Process (a) The TRC shall meet within three (3) regular working days of the request and: PROCEDURES FOR PRESCRIPTION AND ADMINISTRATION OF CHAPTER 0940-01-02 PSYCHOTROPIC MEDICATIONS AT MENTAL HEALTH INSTITUTES 1. Review the patient’s medical record, including documentation regarding the patient’s objections to the use of psychotropic medications and/or physical treatment, attempts by the treatment team to formulate a plan acceptable to the patient, and the recommendation of the treatment team; 2. Interview the patient (unless the patient declines to participate in the TRC meeting); 3. Make the final decision regarding psychotropic medication and/or physical treatment; and 4. Document its review and final decision on a state-approved form in the patient’s medical record. (b) Psychotropic medication and/or physical treatment may be administered to an involuntary patient who does not lack capacity and who withholds informed consent for psychotropic medication and/or physical treatment for up to ninety (90) days upon the approval of the TRC. (c) The TRC may continue to approve use of psychotropic medication and/or physical treatment at ninety (90) day intervals until informed consent for the psychotropic medication and/or physical treatment is obtained, the psychotropic medication and/or physical treatment is discontinued, or the patient is determined to lack capacity to give informed consent and the processes under Rules 0940-01-02-.08, 0940-01-02-.09, or 0940-01-02-.11 are followed. (4) The TRC’s authority expires if the patient subsequently agrees to give informed consent for the psychotropic medication and/or physical treatment. Informed consent shall be obtained from the patient as required by Rules 0940-01-02-.04 and 0940-01-02-.06 before further administration of psychotropic medication and/or provision of physical treatment. (5) The PRA shall see the patient at least every thirty (30) days, document comments and/or recommendations in the patient’s medical record, and shall request additional review by the TRC, if indicated. The PRA may, if indicated, request that a physician, licensed practitioner or qualified mental health professional assess the patient to determine whether the patient still has capacity to give informed consent.