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[Code of Federal Regulations]
[Title 38, Volume 1]
[Revised as of July 1, 2003]
From the U.S. Government Printing Office via GPO Access
[CITE: 38CFR17.33]

[Page 593-596]
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            TITLE 38--PENSIONS, BONUSES, AND VETERANS' RELIEF
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                CHAPTER I--DEPARTMENT OF VETERANS AFFAIRS
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PART 17--MEDICAL--Table of Contents
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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=20
harm and appropriate privacy with regard to their personal needs.
    (2) Patients have a right to receive, to the extent of eligibility=20
therefor under the law, prompt and appropriate treatment for any=20
physical or emotional disability.

[[Page 594]]

    (3) Patients have the right to the least restrictive conditions=20
necessary to achieve treatment purposes.
    (4) No patient in the Department of Veterans Affairs medical care=20
system, except as otherwise provided by the applicable State law, shall=20
be denied legal rights solely by virtue of being voluntarily admitted or =

involuntarily committed. Such legal rights include, but are not limited=20
to, the following:
    (i) The right to hold and to dispose of property except as may be=20
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=20
annulment;
    (vi) The right to hold a professional, occupational, or vehicle=20
operator's license.
    (b) Residents and inpatients. Subject to paragraph (c) of this=20
section, patients admitted on a residential or inpatient care basis to=20
the Department of Veterans Affairs medical care system have the=20
following rights:
    (1) Visitations and communications. Each patient has the right to=20
communicate freely and privately with persons outside the facility,=20
including government officials, attorneys, and clergymen. To facilitate=20
these communications each patient shall be provided the opportunity to=20
meet with visitors during regularly scheduled visiting hours, convenient =

and reasonable access to public telephones for making and receiving=20
phone calls, and the opportunity to send and receive unopened mail.
    (i) Communications with attorneys, law enforcement agencies, or=20
government officials and representatives of recognized service=20
organizations when the latter are acting as agents for the patient in a=20
matter concerning Department of Veterans Affairs benfits, shall not be=20
reviewed.
    (ii) A patient may refuse visitors.
    (iii) If a patient's right to receive unopened mail is restricted=20
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=20
for the sole purpose of ascertaining whether the mail contains=20
contraband material, i.e., implements which pose significant risk of=20
bodily harm to the patient or others or any drugs or medication. Any=20
such material will be held for the patient or disposed of in accordance=20
with instructions concerning patients' mail published by the Veterans=20
Health Administration, Department of Veterans Affairs, and/or the local=20
health care facility.
    (iv) Each patient shall be afforded the opportunity to purchase, at=20
the patient's expense, letter writing material including stamps. In the=20
event a patient needs assistance in purchasing writing material, or in=20
writing, reading or sending mail, the medical facility will attempt, at=20
the patient's request, to provide such assistance by means of=20
volunteers, sufficient to mail at least one (1) letter each week.
    (v) All information gained by staff personnel of a medical facility=20
during the course of assisting a patient in writing, reading, or sending =

mail is to be kept strictly confidential except for any disclosure=20
required by law.
    (2) Clothing. Each patient has the right to wear his or her own=20
clothing.
    (3) Personal Possessions. Each patient has the right to keep and use =

his or her own personal possessions consistent with available space,=20
governing fire safety regulations, restrictions on noise, and=20
restrictions on possession of contraband material, drugs and=20
medications.
    (4) Money. Each patient has the right to keep and spend his or her=20
own money and to have access to funds in his or her account in=20
accordance with instructions concerning personal funds of patients=20
published by the Veterans Health Administration.
    (5) Social Interaction. Each patient has the right to social=20
interaction with others.
    (6) Exercise. Each patient has the right to regular physical=20
exercise and to be outdoors at regular and frequent intervals.=20
Facilities and equipment for such exercise shall be provided.
    (7) Worship. The opportunity for religious worship shall be made=20
available to each patient who desires such opportunity. No patient will=20
be coerced into

[[Page 595]]

engaging in any religious activities against his or her desires.
    (c) Restrictions. (1) A right set forth in paragraph (b) of this=20
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=20
that a valid and sufficient reason exists for a restriction, and
    (ii) The order imposing the restriction and a progress note=20
detaining the indications therefor are both entered into the patient's=20
permanent medical record.
    (2) For the purpose of this paragraph, a valid and sufficient reason =

exists when, after consideration of pertinent facts, including the=20
patient's history, current condition and prognosis, a health or mental=20
health professional reasonably believes that the full exercise of the=20
specific right would--
    (i) Adversely affect the patient's physical or mental health,
    (ii) Under prevailing community standards, likely stigmatize the=20
patient's reputation to a degree that would adversely affect the=20
patient's return to independent living,
    (iii) Significantly infringe upon the rights of or jeopardize the=20
health or safety of others, or
    (iv) Have a significant adverse impact on the operation of the=20
medical facility, to such an extent that the patient's exercise of the=20
specific right should be restricted. In determining whether a patient's=20
specific right should be restricted, the health or mental health=20
professional concerned must determine that the likelihood and=20
seriousness of the consequences that are expected to result from the=20
full exercise of the right are so compelling as to warrant the=20
restriction. The Chief of Service or Chief of Staff, as designated by=20
local policy, should concur with the decision to impose such=20
restriction. In this connection, it should be noted that there is no=20
intention to imply that each of the reasons specified in paragraphs=20
(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=20
patient's rights set forth in paragraph (c)(1) of this section, the=20
least restrictive method for protecting the interest or interests=20
specified in paragraphs (c)(2)(i) through (iv) of this section that are=20
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=20
days by the practitioner and must be concurred in by the Chief of=20
Service or Chief of Staff.
    (d) Restraint and seclusion of patients. (1) Each patient has the=20
right to be free from physical restraint or seclusion except in=20
situations in which there is a substantial risk of imminent harm by the=20
patient to himself, herself, or others and less restrictive means of=20
preventing such harm have been determined to be inappropriate or=20
insufficient. Patients will be physically restrained or placed in=20
seclusion only on the written order of a physician. The reason for any=20
restraint order will be clearly documented in the progress notes of the=20
patient's medical record. The written order may be entered on the basis=20
of telephonic authority received from a physician, but in such an event=20
the ordering physician must examine the patient and sign the written=20
order within twelve (12) hours of giving the order for restraint or=20
seclusion. In emergency situations, where inability to contact a=20
physician prior to restraint is likely to result in immediate harm to=20
the patient or others, the patient may be temporarily restrained by a=20
member of the staff until appropriate authorization can be received from =

a physician. Use of restraints or seclusion shall be for no more than=20
twenty-four (24) hours, at which time the physician shall again be=20
consulted to determine if continuance of such restraint or seclusion is=20
required. Restraint or seclusion may not be used as a punishment, for=20
the convenience of staff, or as a substitute for treatment programs.

[[Page 596]]

    (2) While in restraint or seclusion, the patient must be seen at=20
least once every twelve (12) hours by an appropriate health professional =

who will monitor and chart the patient's physical and mental condition=20
and by other ward personnel as frequently as is reasonable under=20
existing circumstances, but no less than once each hour.
    (3) Each patient in restraint or seclusion shall have bathroom=20
privileges according to his or her needs.
    (4) Each patient in restraint or seclusion shall have the=20
opportunity to bathe at least every twenty-four (24) hours.
    (5) Each patient in restraint or seclusion shall be provided=20
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=20
administered only on the written order of a physician in that patient's=20
medical record. The written order may be entered on the basis of=20
telephonic authority received from a physician, but in such event a=20
physician must countersign the written order within 24 hours of the=20
ordering of the medication. The attending physician shall be responsible =

for all medication given or administered to a patient. The attending=20
physician shall review the drug regimen of each patient under his or her =

care at least every thirty (30) days. It is recognized that=20
administration of certain medications will be reviewed more frequently.=20
Medication shall not be used as punishment, for the convenience of the=20
staff, or in quantities which interfere with the patient's treatment=20
program.
    (f) Confidentiality. Information gained by staff from the patient or =

the patient's medical record will be kept confidential and will not be=20
disclosed except in accordance with applicable law.
    (g) Patient grievances. Each patient has the right to present=20
grievances with respect to perceived infringement of the rights=20
described in this section or concerning any other matter on behalf of=20
himself, herself or others, to staff members at the facility in which=20
the patient is receiving care, other Department of Veterans Affairs=20
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,=20
the patient or his/her representative shall be informed of the rights=20
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=20
patients will be given a copy of the statement of rights and these=20
rights will be discussed with them by their immediate supervisor.
    (i) Other rights. The rights described in this section are in=20
addition to and not in derogation of any statutory, constitutional or=20
other legal rights.

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

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

                  Tentative Eligibility Determinations