chapter 28 – mental
health: state operated facilities and services
SUBCHAPTER 28a ‑ COMMITTEES AND PROCEDURES
SECTION .0100 – SCOPE and DEFINITIONS
10A NCAC 28A .0101 SCOPE
(a) The purpose of the rules in Subchapters 28A, 28B, 28C
and 28D of this Chapter is to set forth regulations governing human rights for
clients in state facilities. The state facilities governed by these Rules are
the regional psychiatric hospitals, mental retardation centers, alcohol and
drug abuse treatment centers, Wright School, the North Carolina Special Care
Center at Wilson, Whitaker School and any other like state owned and operated
institutions, hospitals, centers or schools that may be established under the
administration of the Division. In addition to these Rules, each state
facility shall follow the North Carolina General Statutes regarding client
rights which are specified in Article 3 of Chapter 122C.
(b) A state facility that is certified by the Centers for
Medicare and Medicaid Services (CMS) as an Intermediate Care Facility for the
Mentally Retarded (ICF/MR), or a Medicare/Medicaid Hospital or a Psychiatric
Residential Treatment Facility (PRTF) is
deemed to be in compliance with the rules in Subchapters 28A, 28B, 28C and 28D
of this Chapter, with the exceptions of 28A .0102; 28D .0203; .0206; .0207;
.0208; .0209 and .0210. A state facility that is certified as specified in
Paragraph (b) of this Rule shall comply with the following:
(1) use of the definition of physical restraint
as specified in Subparagraph .0102 (b)(32) of this Section;
(2) documentation requirements as specified in
Rules .0203; .0206; .0207; .0208; .0209 and .0210 of Subchapter 28D;
(3) debriefing requirements as specified in
Rule .0206 of Subchapter 28D; and
(4) training requirements as specified in Rules
.0209 and .0210 of Subchapter 28D.
History Note: Authority G.S. 122C‑51; 143B‑17;
143B‑147;
Eff. October 1, 1984;
Amended Eff. October 1, 2004; April 1, 1990; July 1,
1989.
10A ncac 28A .0102 DEFINITIONS
(a) In addition to the definitions contained in this Rule,
the terms defined in G.S. 122C‑3, 122C‑4 and 122C‑53(f) also
apply to all rules in Subchapters 28A, 28B, 28C, and 28D of this Chapter.
(b) As used in the rules in Subchapters 28A, 28B, 28C, and
28D of this Chapter, the following terms have the meanings specified:
(1) "Abuse" means the infliction of
physical or mental pain or injury by other than accidental means; or
unreasonable confinement; or the deprivation by an employee of services which
are necessary to the mental and physical health of the client. Temporary
discomfort that is part of an approved and documented treatment plan or use of
a documented emergency procedure shall not be considered abuse.
(2) "Associate Professional (AP)"
within the mental health, developmental disabilities and substance abuse
services (mh/dd/sas) system of care means an individual who is a:
(A) graduate of a college or university with a Masters
degree in a human service field with less than one year of full-time,
post-graduate degree accumulated mh/dd/sa experience with the population
served, or a substance abuse professional with less than one year of full-time,
post-graduate degree accumulated supervised experience in alcoholism and drug
abuse counseling. Upon hiring, an individualized supervision plan shall be
developed and supervision shall be provided by a qualified professional with
the population served until the individual meets one year of experience; or
(B) graduate of a college or university with a
bachelor's degree in a human service field with less than two years of
full-time, post-accumulated mh/dd/sa experience with the population served, or
a substance abuse professional with less than two years of full-time, post-bachelor's
degree accumulated supervised experience in alcoholism and drug abuse
counseling. Upon hiring, an individualized supervision plan shall be developed
and reviewed annually. Supervision shall be provided by a qualified
professional with the population served until the individual meets two years of
experience; or
(C) graduate of a college or university with a
bachelor's degree in a field other than human services with less than four
years of full-time, post bachelor's degree accumulated mh/dd/sa experience with
the population served, or a substance abuse professional with less than four
years of full-time, post-bachelor's degree accumulated supervised experience in
alcoholism and drug abuse counseling. Upon hiring, an individualized
supervision plan shall be developed and reviewed annually. Supervision shall
be provided by a qualified professional with the population served until the
individual meets four years of experience; or
(D) registered nurse who is licensed to practice in the
State of North Carolina by the North Carolina Board of Nursing with less than
four years of full-time accumulated experience in mh/dd/sa with the population
served. Upon hiring, an individualized supervision plan shall be developed and
reviewed annually. Supervision shall be provided by a qualified professional
with the population served until the individual meets four years of experience.
(3) "Basic necessities" mean the
essential items or substances needed to support life and health which include,
but are not limited to, a nutritionally sound diet balanced during three meals
per day, access to water and bathroom facilities at frequent intervals,
seasonable clothing, medications to control seizures, diabetes and other like
physical health conditions, and frequent access to social contacts.
(4)
"Certified clinical supervisor (CCS)" means an individual who
is certified as such by the North Carolina Substance Abuse Professional
Certification Board.
(5) "Certified substance abuse counselor
(CSAC)" means an individual who is certified as such by the North Carolina
Substance Abuse Professional Certification Board.
(6) "Client record" means any record
made of confidential information.
(7) "Clinical Director" means Medical
Director, Director of Medical Services or such person acting in the position of
Clinical Director, or his designee.
(8) "Clinically competent" means
authorization by the State Facility Director for a qualified professional to
provide specific treatment/habilitation services to clients based on the
professional's education, training, experience, competence and judgment.
(9) "Consent" means concurrence by a
client or his legally responsible person following receipt of information from
the qualified professional who will administer the proposed treatment or
procedure. Informed consent implies that the client or his legally responsible
person was provided with information concerning proposed treatment, including
both benefits and risks, in order to make an educated decision with regard to
such treatment.
(10) "Dangerous articles or substances"
mean, but are not limited to, any weapon or potential weapon, heavy blunt
object, sharp objects, potentially harmful chemicals, or drugs of any sort,
including alcohol.
(11) "Division Director" means the
Director of the Division or his designee.
(12) "Emergency" means a situation in a
state facility in which a client is in imminent danger of causing abuse or
injury to self or others, or when substantial property damage is occurring as a
result of unexpected and severe forms of inappropriate behavior, and rapid
intervention by the staff is needed. [See Subparagraph (b)(25) of this Rule
for definition of medical emergency].
(13) "Emergency surgery" means an
operation or surgery performed in a medical emergency [as defined in Subparagraph
(b)(25) of this Rule] where informed consent cannot be obtained from an
authorized person, as specified in G.S. 90‑21.13, because the delay would
seriously worsen the physical condition or endanger the life of the client.
(14) "Exclusionary time‑out"
means the removal of a client to a separate area or room from which exit is not
barred for the purpose of modifying behavior.
(15) "Exploitation" means the use of a
client or her/his resources including borrowing, taking or using personal
property with or without her/his permission for another person's profit,
business or advantage.
(16) "Forensic Division" means the unit
at Dorothea Dix Hospital which serves clients who are:
(A) admitted for the purpose of evaluation for capacity
to proceed to trial;
(B) found not guilty by reason of insanity;
(C) determined incapable of proceeding to trial; or
(D) deemed to require a more secure environment to
protect the health, safety and welfare of clients, staff and the general
public.
(17) "Grievance" means a verbal or
written complaint by or on behalf of a client concerning a situation within the
jurisdiction of the state facility. A grievance does not include complaints
that can be resolved without delay by staff present. A complaint that is not
resolved shall be filed and processed in accordance with the requirements of
10A NCAC 28B .0203.
(18) "Human Rights Committee" means a
committee, appointed by the Secretary, to act in a capacity regarding the
protection of client rights.
(19) "Independent psychiatric consultant"
means a licensed psychiatrist not on the staff of the state facility in which
the client is being treated. The psychiatrist may be in private practice, or
be employed by another state facility, or be employed by a facility other than
a state facility as defined in G.S. 122C‑3(14).
(20) "Interpreter services" means
specialized communication services provided for the hearing impaired by
interpreters certified by the National Registry of Interpreters for the Deaf or
the National Association of the Deaf.
(21) "Involuntary client" means a
person admitted to any regional psychiatric hospital or alcoholic
rehabilitation center under the provisions of Article 5, Parts 7, 8 or 9 of
G.S. 122C and includes but it is not limited to clients detained pending a
district court hearing and clients involuntarily committed after a district
court hearing. This term shall also include individuals who are defendants in
criminal actions and are being evaluated in a state facility for mental
responsibility or mental competency as a part of such criminal proceedings as
specified in G.S. 15A‑1002 unless a valid order providing otherwise is
issued from a court of competent jurisdiction and the civil commitment of
defendants found not guilty by reason of insanity as specified in G.S. 15A‑1321.
(22) "Isolation time‑out" means
the removal of a client to a separate room from which exit is barred but which
is not locked and where there is continuous supervision by staff for the
purpose of modifying behavior.
(23) "Licensed professional counselor
(LPC)" means a counselor who is licensed as such by the North Carolina
Board of Licensed Professional Counselors.
(24) "Major physical injury" means
damage caused to the body resulting in profuse bleeding or contusion of
tissues; fracture of a bone; damage to internal organs; loss of consciousness;
loss of normal neurological function (inability to move or coordinate
movement); or any other painful condition caused by such injury.
(25) "Medical emergency" means a
situation where the client is unconscious, ill, or injured, and the reasonably
apparent circumstances require prompt decisions and actions in medical or other
health care, and the necessity of immediate health care treatment is so
reasonably apparent that any delay in the rendering of the treatment would
seriously worsen the physical condition or endanger the life of the client.
(26) "Minimal risk research" means that
the risks of harm anticipated in the proposed research are not greater,
considering probability and magnitude, than those ordinarily encountered in
daily life or during the performance of routine physical or psychological
examinations or tests.
(27) "Minor client" means a person
under 18 years of age who has not been married or who has not been emancipated
by a decree issued by a court of competent jurisdiction or is not a member of
the armed forces.
(28) "Neglect" means the failure to
provide care or services necessary to maintain the mental and physical health
of the client.
(29) "Normalization" means the
principle of helping the client to obtain an existence as close to normal as
possible, taking into consideration the client's disabilities and potential, by
making available to him patterns and conditions of everyday life that are as
close as possible to the norms and patterns of the mainstream of society.
(30) "Paraprofessional" within the
mh/dd/sa system of care means an individual who, with the exception of staff
providing respite services or personal care services, has a GED or high school
diploma; or no GED or high school diploma, employed prior to November 1, 2001 to provide a mh/dd/sa service. Upon hiring, an individualized
supervision plan shall be developed and supervision shall be provided by a
qualified professional or associate professional with the population served.
(31) "Person standing in loco parentis"
means one who has put himself in the place of a lawful parent by assuming the
rights and obligations of a parent without formal adoption.
(32) "Physical Restraint" means the
application or use of any manual method of restraint that restricts freedom of
movement, or the application or use of any physical or mechanical device that
restricts freedom of movement or normal access to one's body, including
material or equipment attached or adjacent to the client's body that he or she
cannot easily remove. Holding a client in a therapeutic hold or any other
manner that restricts his or her movement constitutes manual restraint for that
client. Mechanical devices may restrain a client to a bed or chair, or may be
used as ambulatory restraints. Examples of mechanical devices include cuffs,
ankle straps, sheets or restraining shirts, arm splints, mittens and helmets.
Excluded from this definition of physical restraint are physical guidance,
gentle physical prompting techniques, escorting and therapeutic holds used
solely for the purpose of escorting a client who is walking, soft ties used
solely to prevent a medically ill client from removing intravenous tubes,
indwelling catheters, cardiac monitor electrodes or similar medical devices,
and prosthetic devices or assistive technology which are designed and used to
increase client adaptive skills. Escorting means the temporary touching or
holding of the hand, wrist, arm, shoulder or back for the purpose of inducing a
client to walk to a safe location.
(33) "Protective devices" means an
intervention which provides support for weak and feeble clients or enhances the
safety of behaviorally disordered clients. Such devices may include posey
vests, geri‑chairs or table top chairs to provide support and safety for
clients with physical handicaps; devices such as helmets and mittens for self‑injurious
behaviors; or devices such as soft ties used to prevent medically ill clients
from removing intravenous tubes, indwelling catheters, cardiac monitor
electrodes or similar medical devices. As provided in Rule .0207 of Subchapter
28D, the use of a protective device for behavioral control shall comply with
the requirements specified in Rule .0203 of Subchapter 28D.
(34) "Psychotropic medication" means
medication with the primary function of treating mental illness, personality or
behavior disorders. It includes, but is not limited to, antipsychotics,
antidepressants, antianxiety agents and mood stabilizers.
(35) "Qualified professional" means, within the
mh/dd/sas system of care, an individual who is:
(A) an individual who holds a license, provisional
license, certificate, registration or permit issued by the governing board
regulating a human service profession, except a registered nurse who is
licensed to practice in the State of North Carolina by the North Carolina Board
of Nursing who also has four years of full-time accumulated experience in
mh/dd/sa with the population served; or
(B) a graduate of a college or university with a Masters
degree in a human service field and has one year of full-time, post-graduate
degree accumulated mh/dd/sa experience with the population served, or a
substance abuse professional who has one-year of full-time, post-graduate
degree accumulated supervised experience in alcoholism and drug abuse
counseling; or
(C) a graduate of a college or university with a
bachelor's degree in a human service field and has two years of full-time,
post-bachelor's degree accumulated mh/dd/sa experience with the population
served, or a substance abuse professional who has two years of full-time,
post-bachelor's degree accumulated supervised experience in alcoholism and drug
abuse counseling; or
(D) a graduate of a college or university with a
bachelor's degree in a field other than human services and has four years of
full-time, post-bachelor's degree accumulated mh/dd/sa experience with the
population served, or a substance abuse professional who has four years of
full-time, post-bachelor's degree accumulated supervised experience in
alcoholism and drug abuse counseling.
(36) "Regional alcohol and drug abuse
treatment center" means a state facility for substance abusers as
specified in G.S. 122C‑181(a)(3).
(37) "Regional mental retardation
center" means a state facility for the mentally retarded as specified in
G.S. 122C‑181(a)(2).
(38) "Regional psychiatric hospital"
means a state facility for the mentally ill as specified in G.S. 122C‑181(a)(1).
(39) "Representative payee" means the
person, group, or facility designated by a funding source, such as Supplemental
Security Income (SSI), to receive and handle funds according to the guidelines
of the source on behalf of a client.
(40) "Research" means inquiry involving
a trial or special observation made under conditions determined by the
investigator to confirm or disprove an hypothesis or to explicate some
principle or effect.
(41) "Respite client" means a client
admitted to a mental retardation center for a short‑term period, normally
not to exceed 30 days. The primary purpose of such admission is to provide a
temporary interval of rest or relief for the client's regular caretaker.
(42) "Responsible professional" shall
have the meaning as specified in G.S. 122C‑3 except the "responsible
professional" shall also be a qualified professional as defined in
Subparagraph (b)(35) of this Rule.
(43) "Seclusion" means isolating a
client in a separate locked room for the purpose of controlling a client's
behavior. In the Forensic Service, Pretrial Evaluation Unit and the Forensic
Treatment Program Maximum Security Ward in the Spruill Building at Dorothea Dix Hospital, the use of locked rooms is not considered seclusion for clients
with criminal charges who are:
(A) undergoing pretrial evaluations ordered by a
criminal court;
(B) in treatment for restoration of capacity to proceed;
(C) in treatment to reduce violence risk; or
(D) considered to be an escape risk.
(44) "State Facility Director" means
the chief administrative officer or manager of a state facility or his
designee.
(45) "Strike" means, but is not limited
to, hitting, kicking, slapping or beating whether done with a part of one's
body or with an object.
(46) "Timeout" means the removal of a
client from other clients to another space within the same activity area for
the purpose of modifying behavior.
(47) "Treatment" means the act, method,
or manner of habilitating or rehabilitating, caring for or managing a client's
physical or mental problems.
(48) "Treatment plan" means a written
individual plan of treatment or habilitation for each client to be undertaken
by the treatment team and includes any documentation of restriction of client's
rights.
(49) "Treatment team" means an
interdisciplinary group of qualified professionals sufficient in number and
variety by discipline to adequately assess and address the identified needs of
the client.
(50) "Unit" means an integral component
of a state facility distinctly established for the delivery of one or more
elements of service to which specific staff and space are assigned, and for
which responsibility has been assigned to a director, supervisor, administrator,
or manager.
(51) "Voluntary client" means a person
admitted to a state facility under the provisions of Article 5, Parts 2, 3, 4
or 5 of G.S. 122C.
History Note: Authority G.S. 122C‑3; 122C‑4;
122C‑51; 122C‑53(f); 143B‑147;
Eff. October 1, 1984;
Amended Eff. June 1, 1990; April 1, 1990; July 1, 1989;
Temporary Amendment
Eff. January 1, 1998;
Amended Eff. April 1, 1999;
Temporary Amendment Eff. January 1, 2001;
Temporary Amendment Expired October 13, 2001;
Temporary Amendment Eff. November 1, 2001;
Amended Eff. April 1, 2003.
SECTION .0200 ‑ HUMAN RIGHTS COMMITTEES
10A NCAC 28A .0201 PURPOSE OF HUMAN RIGHTS COMMITTEES
A human rights committee shall be established at each state
facility to provide an additional safeguard for protecting the human, civil,
legal and treatment rights of clients who, due to impairments resulting from
mental retardation, mental illness or substance abuse, may be less able to
articulate and exercise their legal entitlements than those not impaired.
History Note: Authority G.S. 122C‑64; 131E‑67;
143B‑147;
Eff. October 1, 1984;
Amended Eff. July 1, 1989.
10A NCAC 28A .0202 MEMBERSHIP
(a) Members of human rights committees shall be appointed
by the Secretary.
(b) Recommendations for committee appointments and the
appointment process shall be as follows:
(1) The State Facility Director shall maintain
a schedule of the terms of appointment for committee members and shall request
names of possible appointees from voluntary groups serving the mentally ill,
mentally retarded or substance abusers, as appropriate, as well as from the
Chairperson of the State Facility Human Rights Committee six months prior to
the expiration of a committee member's term. The State Facility Director shall
submit these nominations, as well as any additional nominations, to the
appropriate deputy director in the Division five months prior to the expiration
of the Committee member's term.
(2) Within two weeks following receipt of the
nominations, the Deputy Director shall submit the Committee and voluntary group
recommendations for nominations, as well as any other nominations supported by
the Deputy Director, to the Division Director.
(3) The Division Director shall submit the
committee and voluntary group recommendations, as well as any other
nominations he supports, to the Secretary four months prior to the expiration
of the Committee member's term of office.
(4) The Secretary shall contact his choices for
potential appointees, explain committee member responsibilities and confirm
appointments in writing.
(5) The Secretary shall notify the Division
Director and the committee chairperson of confirmed committee appointments and
the term of office for appointees two months prior to the expiration of the
Committee member's term.
(6) The Division Director shall notify the
State Facility Director of the appointment.
(c) Appointments shall be made with an effort to consider
the geographic distribution, race and sex composition of the Human Rights
Committees.
(d) Members shall represent only one of the organizations
or professional groups indicated in Paragraphs (e), (f), (g), (h) and (i) of
this Rule during any single term in their capacity as human rights committee
members.
(e) Each regional psychiatric hospital shall have a
committee consisting of ten members, none of whom shall be currently employed
by the Division or attorney general's office.
(1) All members shall be knowledgeable about
mental health and mental illness issues as evidenced by interest, experience or
education.
(2) Appointments shall be made with an effort
to consider representation of the needs and characteristics of the state
facility clients.
(3) Appointees shall include one member from
the North Carolina Mental Health Association; one member from the North
Carolina Alliance for the Mentally Ill; and one member from the North Carolina
Association for Retarded Citizens.
(4) Four members shall be appointed at large.
(5) At least one member shall be a client and
at least one member shall be a family member.
(6) One member shall be a licensed attorney.
(f) Each regional mental retardation center shall have a
committee consisting of ten members, none of whom shall be currently employed
by the Division.
(1) Four of the Committee members shall include
the legally responsible person of persons with mental retardation who may or
may not reside in a state facility, persons with mental retardation, and at
least one client of a regional mental retardation center.
(2) Three members shall be professionals from
three different associated fields such as social work, education, psychology or
medicine.
(3) One member shall be a licensed attorney.
(4) Two members shall be selected at large.
(g) Each regional alcoholic rehabilitation center shall
have a committee consisting of five members, none of whom shall be currently
employed by the Division.
(1) Two persons shall be members of voluntary
groups representing the interests of persons having substance abuse problems.
(2) One person shall be a client or family
member of a client of an alcoholic rehabilitation center.
(3) Two members shall be selected at large.
(h) Wright School, Whitaker School and any other like state
facility established and administered by the Division to serve emotionally
disturbed children and adolescents each shall have a committee consisting of
five members, none of whom shall be currently employed by the Division.
(1) Two persons shall be members of voluntary
groups representing the interest of children and adolescents with special
needs.
(2) One person shall be the legally responsible
person of a client of a state facility for emotionally disturbed children.
(3) Two members shall be selected at large.
(i) North Carolina Special Care Center at Wilson and any
other like state facility established and administered by the Division shall
have a committee consisting of five members, none of whom shall be currently
employed by the Division.
(1) All members shall be knowledgeable about
mental health and nursing care issues as evidenced by interest, experience or
education.
(2) Four members shall be appointed at large.
(3) At least one member shall be a client or
family member of a client.
History Note: Authority G.S. 122C‑64; 131E‑67;
143B‑10; 143B‑147;
Eff. October 1, 1984;
Amended Eff. April 1, 1990; July 1, 1989.
10A NCAC 28A .0203 EX OFFICIO MEMBERSHIP
(a) An internal client advocate may serve as a non‑voting
member of each human rights committee.
(b) In addition to the members appointed by the Secretary,
the Chairperson may designate other non‑voting ex officio members to
assist the Committee. Ex officio members may be employees of the Division.
History Note: Authority G.S. 122C‑64; 131E‑67;
143B‑147;
Eff. October 1, 1984;
Amended Eff. July 1, 1989.
10A NCAC 28A .0204 TERMS OF OFFICE
(a) All members shall be appointed to serve three year
terms except for the initial terms at state facilities which did not have human
rights committees established upon the original effective date of these rules.
(b) Initial appointments for each of the Committees
established under Paragraph (a) of this Rule shall be as follows:
(1) One member shall serve a four‑year
term, expiring June 30.
(2) Two members shall serve a three‑year
term, expiring June 30.
(3) One member shall serve a two‑year
term, expiring June 30.
(4) One member shall serve a one‑year
term, expiring June 30.
(c) Members may be appointed for no more than two
consecutive three‑year terms.
(d) If a vacancy occurs due to death, resignation or
disqualification, the Human Rights Committee Chairperson shall notify the State
Facility Director who shall initiate procedures to fill the vacancy in
accordance with Rule .0202(b) in this Section. Members appointed in this
manner shall serve out the term of the member who created the vacancy and shall
represent the category of membership represented by the member whose place they
are selected to fill.
(e) Human rights committee members whose appointment terms
have expired may continue to serve on the Committee until such time that the
Committee member is notified by the State Facility Director that another
appointment has been made and the Committee member's term of appointment has
officially expired.
(f) If a member misses three consecutive meetings without
being excused by the Chairperson, the Chairperson shall notify the Secretary.
Missing three consecutive meetings without being excused by the Chairperson
shall constitute good cause for being removed from the Committee.
(g) The Secretary shall have the authority to remove any
member of a human rights committee from office for good cause.
History Note: Authority G.S. 122C‑64; 131E‑67;
143B‑10; 143B‑147;
Eff. October 1, 1984;
Amended Eff. April 1, 1990; July 1, 1989.
10A NCAC 28A .0205 OFFICERS
(a) Each human rights committee shall elect by a majority a
chairperson to serve for a period of two years. No person shall serve more
than two consecutive terms as chairperson. The chairperson shall be a
committee member who does not work directly with clients at the state facility.
(b) Other officers may be elected as needed based on a
majority vote of the Committee.
History Note: Authority G.S. 122C‑64; 131E‑67;
143B‑147;
Eff. October 1, 1984;
Amended Eff. July 1, 1989.
10A NCAC 28A .0206 MEETINGS
(a) Each human rights committee shall meet at least monthly
unless an alternative schedule is approved by the Secretary but in no case less
than six times per year. Committees may meet more often as necessary at the
call of the Chairperson. The chairperson shall call a meeting of the committee
at any time such is requested by four or more members of a ten‑member
committee or two or more members of a five‑member committee.
(b) A majority of each committee shall constitute a quorum
for the transaction of business.
(c) Human rights committees as public bodies are subject to
open meetings as specified in G.S. 143‑318.9 through 143‑318.12.
Due to the nature of the deliberations of human rights committees, it is
anticipated that some of the issues would be discussed in executive session in
accordance with G.S. 143‑318.11(a)(7) and (a)(12). The chairperson shall
file a schedule of regular meetings with the Secretary of State as specified in
G.S. 143‑318.12.
History Note: Authority G.S. 122C‑64; 131E‑67;
143B‑10; 143B‑147;
Eff. October 1, 1984.
10A NCAC 28A .0207 DUTIES
(a) The duties of the Human Rights Committees are as
follows:
(1) review of compliance with laws in G.S.
122C, Article 3, dealing with the rights of clients, and reviewing the state
facility's compliance with the human rights rules in this Subchapter and
Subchapter 28B through 28D of this Chapter;
(2) reviewing and assessing the efficiency of
existing and proposed methods and procedures for protecting the rights of
clients of their respective state facilities;
(3) serving as an independent review body to
hear and make recommendations concerning alleged violations of the rights of
individuals and groups brought by clients, client advocates, parents,
guardians, state facility employees, or others, in compliance with Rule .0209 of
this Section for any necessary review of the client record;
(4) reviewing programs and services that deal
with the legal and human rights of clients;
(5) reviewing cases of alleged abuse, neglect
or exploitation or failure to provide services of whatever nature brought by
clients, client advocates, parents, guardians, state facility employees, or
others, in compliance with Rule .0209 of this Section for any necessary review
of the client record;
(6) reviewing cases brought by clients, client
advocates, parents, guardians, state facility employees, or others regarding
the use of seclusion, physical or mechanical restraint, intrusive or aversive
procedures, electroconvulsive therapy, medication prescribed above recommended
dosages as specified in 10A NCAC 28I .0300 or any procedures carried out
against the will of the client. The Committee may determine the extent of the
review, including but not limited to statistical review and individual case
review involving a review in compliance with Rule .0209 of this Section of the
client record;
(7) reviewing complaints, grievances or other
client rights issues of concern brought by clients, client advocates, parents,
guardians, state facility employees, or others in compliance with Rule .0209 of
this Section for any necessary review of the client record; and
(8) reviewing any issues of concern brought by
the State Facility Director, Division Director, a Deputy Director, or the
Secretary.
(b) The duties listed in Paragraph (a) of this Rule shall
not be interpreted to allow human rights committees to concern themselves with
the management of the respective state facilities except where there is an
issue of violation of a client's rights.
(c) Annually, by September 1, each committee shall submit,
through the Division Director to the Secretary, a report of its activities,
accomplishments, and recommendations for the previous year, July 1 through June
30.
History Note: Authority G.S. 122C‑64; 131E‑67;
143B‑10; 143B‑147;
Eff. October 1, 1984;
Amended Eff. July 1, 1989.
10A NCAC 28A .0208 PROCEDURES
(a) There shall be a written agreement governing the
relationship and responsibilities of the State Facility Director, Human Rights
Committee and client advocate. Such agreement may be superseded by any written
agreements between the Division and the Governor's Advocacy Council for Persons
with Disabilities.
(b) If the majority of the Human Rights Committee feels
that an issue requires action, the Chairperson of the Committee shall submit a
written statement regarding the issue to the State Facility Director and
indicate a desired response date. The issue shall be brought to the attention
of the State Facility Director. If the Committee is not satisfied with the
actions of the State Facility Director, the issue shall be brought to the
attention of the Division Director and the appropriate deputy director
simultaneously. If the Committee is not satisfied with the action of the
Division Director or the Deputy Director involved, the issue shall be brought
to the attention of the Secretary.
(c) If the majority of the Committee votes that an issue
does not require action, but two or more members feel strongly that some action
is necessary, these members may submit a minority report to the State Facility
Director, the Division Director and Deputy Director, and the Secretary in the
same manner as a majority decision.
(d) In cases deemed appropriate by the Committee, steps in
the communications procedure as outlined in Paragraph (b) of this Rule may be
omitted, provided that the person in authority in each omitted step is notified
in writing.
(e) The Committee may also seek help in solving problems
from the Governor's Advocacy Council for Persons With Disabilities, Governor's
Advocacy Council on Children and Youth, the Commission for Mental Health,
Developmental Disabilities and Substance Abuse Services, and the Council on
Developmental Disabilities. In these cases, persons in authority at each step
of the prescribed communications procedure as outlined in Paragraph (b) of this
Rule shall be notified in writing. Minority report procedures, as outlined in
Paragraph (c) of this Rule, shall be applicable in this procedure as well.
History Note: Authority G.S. 122C‑64; 131E‑67;
143B‑147;
Eff. October 1, 1984;
Amended Eff. April 1, 1990; July 1, 1989.
10a NCAC 28a .0209 CONFIDENTIALITY
(a) Committee members shall have access to the records of
clients only upon written consent of the client or legally responsible person
as specified in 10A NCAC 26B .0209 "Confidentiality Rules", division
publication APSM 45‑1. This document is available for inspection in each
state facility or in the Publications Office of the Division. This right of
access is granted so that the Committees may perform their duties of overseeing
and monitoring the action of the state facility.
(b) Committee members shall treat the client record as
confidential information as specified in 10A NCAC 26B .0108.
History Note: Authority G.S. 122C‑53(a); 122C‑64;
131E‑67; 143B‑147;
Eff. October 1, 1984;
Amended Eff. July 1, 1989.
10A NCAC 28A .0210 LIMITATIONS ON REPRESENTATION
In order for a professional to be a member of a human rights
committee he must agree not to accept a client of the state facility as a
private client for remuneration for professional services on the client's
behalf during the member's term. If a professional, while a member of the
Committee, accepts such a client, then he becomes disqualified to serve on the
Committee.
History Note: Authority G.S. 122C‑64; 131E‑67;
143B‑147;
Eff. October 1, 1984;
Amended Eff. April 1, 1990; July 1, 1989.
10A NCAC 28A .0211 STATE FACILITY RESPONSIBILITY
(a) The State Facility Director shall provide necessary
clerical and support services to the Human Rights Committee.
(b) The State Facility Director shall provide an
orientation to the state facility for new members of the Committee at the
Chairperson's request.
(c) The State Facility Director shall assure that the
facility's Staff Development Services shall implement the Division's annual
plan of training for human rights committee members.
(d) The State Facility Director shall be responsible for
the reimbursement of mileage expenses for members of the Committee who request
financial assistance to attend regularly scheduled meetings.
History Note: Authority G.S. 122C‑64; 131E‑67;
143B‑147;
Eff. October 1, 1984;
Amended Eff. July 1, 1989.
10A NCAC 28A .0212 DIVISION RESPONSIBILITY
(a) The Division Director shall serve as the point of
contact between the Committees and the Secretary.
(b) The Division's Training Office, in conjunction with the
Governor's Advocacy Council for Persons with Disabilities (GACPD), shall
develop an annual plan of training for human rights committee members.
(c) The Division Director shall provide collaboration
opportunities for each state facility human rights committee and shall assure
an opportunity for committee chairpersons to meet at least annually.
(d) The Division Director shall provide written orientation
materials for all new members. Written training materials shall cover at a
minimum the structure and role of the Division; the role of State Facility
Human Rights Committees; state statutes; and rules codified in the North
Carolina Administrative Code regarding human rights and related areas of
concern. Such materials shall be available in the Quality Assurance Section of
the Division.
History Note: Authority G.S. 122C‑64; 131E‑67;
143B‑147;
Eff. October 1, 1984;
Amended Eff. July 1, 1989.
SECTION .0300 ‑ INFORMING CLIENTS AND STATE FACILITY
EMPLOYEES OF RIGHTS
10A NCAC 28A .0301 INFORMING CLIENTS OF RIGHTS
(a) The State Facility Director shall assure that all
clients and legally responsible persons are informed of the client's rights at the
time of admission or not more than 24 hours after admission [with the
exceptions specifically provided for in Paragraph (b) of this Rule]. The state
facility shall develop a policy which includes, but is not limited to, the
following:
(1) specifying who is responsible for informing
the client;
(2) providing a written copy of rights to
clients who can read and explaining the rights to all clients;
(3) documenting in the client record that
rights have been explained to the client;
(4) posting copies of rights and the person or
office to contact for information regarding rights in areas accessible to the
client.
(5) describing the role of the Human Rights
Committee and internal client advocate and how to utilize their services;
(6) informing the legally responsible person of
a minor or incompetent adult client that he may request notification after any
occurrence of the use of an intervention procedure as specified in 10A NCAC 28D
.0203, .0204 and .0205; and
(7) informing the competent adult client that
he may designate an individual to receive notification, in accordance with G.S.
122C‑53(a), after any occurrence of the use of an intervention procedure
as specified in 10A NCAC 28D .0203, .0204 and .0205.
(b) If the client cannot be informed of his rights within
24 hours after admission because of his condition or if the legally responsible
person cannot be notified within 24 hours after admission, then this exception
and any alternative means of implementing this right shall be documented.
However, the state facility may delay notifying the legally responsible person
of client rights for up to 72 hours when necessary for week‑end
admissions.
History Note: Authority G.S. 122C‑51; 122C‑53;
131E‑67; 143B‑147;
Eff. October 1, 1984;
Amended Eff. April 1, 1990; July 1, 1989.
10A NCAC 28A .0302 INFORMING STATE FACILITY EMPLOYEES
The State Facility Director shall assure that all state
facility employees are informed of the rights of clients and shall develop a
policy which includes but is not limited to the following:
(1) specifying who is responsible for informing new and
existing state facility employees;
(2) distributing written copies of client rights as
specified in Article 3 of Chapter 122C to all state facility employees and
obtaining documentation that state facility employees have read and understand
the client rights;
(3) obtaining documentation that qualified
professionals on staff have read and understand client rights as specified in
Article 3 of Chapter 122C of the N.C. General Statutes and regulations as specified
in 10A NCAC 28A through 28D;
(4) establishing a procedure for training or updating
state facility employees' awareness of client rights as specified in Article 3
of Chapter 122C of the N.C. General Statutes, 10A NCAC 28A, 28B, 28C, and 28D,
and through state facility policy at least annually and whenever changes
occur. Such education shall be documented; and
(5) identifying individuals who can be contacted to
answer questions regarding rights.
History Note: Authority G.S. 122C‑51; 131E‑67;
143B‑147;
Eff. October 1, 1984;
Amended Eff. July 1, 1989.
10A NCAC 28A .0303 NOTIFICATION ON GUARDIANSHIP
(a) The client shall be informed of the different aspects
and policies concerning guardianship when the use of guardianship becomes an
issue.
(b) The client shall be permitted to participate as fully
as possible in all decisions that will affect him. State facility employees
shall seek to preserve for the incompetent adult client the opportunity to
exercise those rights that are within his comprehension as specified in G.S.
35A‑1201(a)(4) and (5).
(c) The State Facility Director shall assure that
incompetency proceedings are pursued for adult clients when the treatment team
determines that the client is unable to make or communicate important decisions
about his life. To the extent possible statutory proceedings for limited
guardianship rather than full guardianship should be pursued.
History Note: Authority G.S. 122C‑51; 131E‑67;
143B‑147;
Eff. October 1, 1984;
Amended Eff. April 1, 1990; July 1, 1989.
10A NCAC 28A .0304 INFORMING CLIENTS OF POLICIES
The State Facility Director shall assure that each client
and the legally responsible person are informed of the following:
(1) the state facility policy on reimbursement or
criminal liability for personal or property damage caused by the client to the
state facility, other clients, employees, visitors or their property;
(2) the state facility policy on charges for treatment
or habilitation services as consistent with 10A NCAC 28C .0310;
(3) the state facility rules and regulations that the
client is expected to follow and possible penalties for violations;
(4) the state facility grievance procedure;
(5) the state facility's authority to initiate, when
appropriate, involuntary commitment procedures for a voluntary client; and
(6) the state facility policy on search and seizure.
History Note: Authority G.S. 122C‑51; 131E‑67;
143B‑147;
Eff. October 1, 1984;
Amended Eff. July 1, 1989.
10A NCAC 28A .0305 RESEARCH
The State Facility Director shall assure that all research
involving human subjects is conducted in accordance with accepted research
practices and is reviewed according to 10A NCAC 26C .0200. Research that
places human subjects at risk, except minimal risk research, shall be subject
to the Department of Health and Human Services policy for the protection of
human research subjects as codified in 45 C.F.R. 46, adopted pursuant to G.S.
150B‑14(c).
History Note: Authority G.S. 122C‑51; 122C‑57;
131E‑67; 143B‑147;
Eff. October 1, 1984;
Amended Eff. April 1, 1990; July 1, 1989.
10A NCAC 28A .0306 CONSENT TO PARTICIPATE IN RESEARCH
(a) The State Facility Director shall assure that all
clients who participate in research, except minimal risk research, elect to do
so after having received a full explanation of the purpose, potential benefits
and risks of participation.
(b) Informed written consent shall be obtained from the
client or legally responsible person for each new research project. Whenever a
client is adjudicated incompetent and is a ward of the state, or whenever a
client adjudicated incompetent or a minor client objects to participation in a
research project, the client shall not participate in the research project.
Consent shall be documented in the client record and shall include:
(1) client or legally responsible person's
signature and date;
(2) brief description of the research project;
(3) length of consent, which shall not exceed
six months without renewal;
(4) notification that consent may be withdrawn
at any time without penalty;
(5) explanation of any potential risks and
plans to reduce or address such risks;
(6) signature and title of the investigator and
date;
(7) disclosure of any established alternative
procedures that would probably achieve similar therapeutic goals as those
anticipated through the research; and
(8) a provision that the client or legally
responsible person will be given notification of any significant changes in the
research procedures which directly affect the client.
History Note: Authority G.S. 122C‑51; 122C‑57;
131E‑67; 143B‑147;
Eff. October 1, 1984;
Amended Eff. July 1, 1989.
