GENERAL STATUTES NOT COVERED

GENERAL STATUTES NOT COVERED

DECLARATION OF POLICY ON CLIENT RIGHTS

It is the policy of the State to assure basic human rights to each client of an agency. These rights include the right to dignity, privacy, humane care, and freedom from mental and physical abuse, neglect, and exploitation. Each agency shall assure to each client the right to live as normally as possible while receiving care and treatment and to receive necessary treatment for prevention of physical ailments.

It is further the policy of this State that each client who is admitted to and is receiving services from an agency has the right to treatment, including access to medical care and habilitation, regardless of age or degree of mental illness, developmental disabilities, or substance abuse. Each client has the right to an individualized written treatment plan, within 30 days of admission, setting forth a program to maximize the development or restoration of his capabilities.

RIGHT TO CONFIDENTIALITY

Except as provided in GS 132-5, confidential information acquired in attending or treating a client is not a public record under Chapter 132 of GS.

Except as authorized by GS 122C-53-56, no individual having access to confidential information may disclose this information.

Except as provided in GS 122C-53-56, each client has the right that no confidential information acquired be disclosed by the agency.

No provision of GS 122C-205 & GS 122C-53-56 permitting disclosure of confidential information may apply to the records of a client when federal statutes or regulations applicable to that client prohibit the disclosure of this information.

Except as required or permitted by law, disclosure of confidential information to someone not authorized to receive the information is a Class 3 misdemeanor and is punishable only by a fine, not to exceed five hundred dollars ($500.00)

EXCEPTION; CLIENT

An agency may disclose confidential information if the client or his legally responsible person consents in writing to the release of the information to a specified person. This release is valid for a specified length of time and subject to revocation by the consenting individual.

An agency may disclose the fact of admission or discharge of a client to the client's next of kin whenever the responsible professional determines that the disclosure is in the best interest of the client.

Upon request a client shall have access to confidential information in his client record except information that would be injurious to the client's physical or mental well-being as determined by the attending physician or, if there is none, by the agency director or his designee. 

If the attending physician or, if there is one, the agency director or his designee has refused to provided confidential information to a client, the client may request that the information be sent to a physician or psychologist of the client' choice, and in this event the information shall be so provided.

Except as provided by GS 90-21.4(b), upon request the legally responsible person of a client shall have access to confidential information in the client's record; except information that would be injurious to the client's physical or mental well-being as determined by the attending physician or, if there is no one, by the agency director or his designee. If the attending physician or, if there is none, the agency director or his designee has refused to provided confidential information to the legally responsible person, the legally responsible person may 

request that the information be sent to a physician or psychologist of the legally responsible person's choice and in this event the information shall be so provided.

A client advocate's access to confidential information and his responsibility for safeguarding this information are 

as provided by subsection (g) of this section.

This statue provides definitions of advocates:

An internal client advocate shall be granted, without the consent of the client or his legally responsible person, access to routine reports and other confidential information necessary to fulfill his monitoring and advocacy functions. In his role, the internal client advocate may disclose confidential information received to the client involved, to his legally responsible person, to the director of the agency or his designee, to other individuals within the agency who are involved in the treatment or habilitation of the client, or to the Secretary in accordance with the rules of the Commission. Any further disclosure shall require the written consent of the client and his legally responsible person. An external client advocate shall have access to confidential information only upon the written consent of the client and his legally responsible person. In this rule, the external client advocate may use the information only as authorized by the client and his legally responsible person.

Upon the request of (i) a client who is an adult and who has not been adjudicated incompetent under Chapter 35 or former Chapters 33 or 35 of the GS, or (ii) the legally responsible person for any other client, an agency shall disclose to an attorney confidential information relating to that client.

EXCEPTION; PROTECTION FROM ABUSE AND EXPLOITATION; REPORTING

1. An employee of or a volunteer at The Ship Group Community Services Care who, other than as a part of generally accepted medical or therapeutic procedure, knowingly causes pain or injury to a client or borrows or takes personal property from a client is guilty of a Class 1 misdemeanor. Any employee or volunteer who uses reasonable force to carry out the provisions of G.S. 122C-60 or to protect himself or others from a violent client does not violate this subsection.   

2. An employee of The Ship Group Community Services Care who witnesses or has knowledge of a violation of subsection (a) or of an accidental injury to a client shall report the violation or accidental injury to the Executive Director or his designee. No employee making a report may be threatened or harassed by any other employee or volunteer on account of the report. Violation of this subsection is a Class 3 misdemeanor punishable only by a fine, not to exceed five hundred dollars ($500.00).

3. The identity of an individual who makes a report under this section or who cooperates in an ensuing investigation may not be disclosed without his consent, except to persons authorized by The Ship Group Community Services Care or by State or federal law to investigate or prosecute these incidents, or in a grievance or personnel hearing or civil or criminal action in which a reporting individual is testifying, or when disclosure is legally compelled or authorized by judicial discovery. This subsection shall not be interpreted to require the disclosure of the identity of an individual where it is otherwise prohibited by law.

4. An employee who makes a report in good faith under this section is immune from any civil liability that might otherwise occur for the report. In any case involving liability, making of a report under this section is prima facie evidence that the maker acted in good faith.

5. The duty imposed by this section is in addition to any duty imposed by G.S. 7B-301 or G.S. 108A-102.

6. The Ship Group Community Services Care shall investigate or provide for the investigation of all reports made under the provisions of this section. 

EXCEPTIONS; ABUSE REPORTS AND COURT PROCEEDINGS

An agency shall disclose confidential information if a court of competent jurisdiction issues an order compelling 

disclosure.

If an individual is a defendant in a criminal case and a mental examination of the defendant has been ordered by the court as provided in 

GS 15A-1002, the agency shall send the results or the report of the mental examination to the clerk of court, to the district attorney or prosecuting officer, and to the attorney of record for the defendant as provide in GS 15A-1002(d).An agency may disclose confidential information to an attorney who represents either the agency or an employee of the agency, if which information is relevant to litigation, to the operations of the agency, or to the provision of services by the agency. An employee may discuss confidential information with his attorney or with an attorney representing the agency in which he is employed.

The Ship Group Community Services may disclose confidential information if in the best interest of the individual, in order to file a petition for competency/guardianship purposes.

An agency shall disclose confidential information for purposes of complying with Article 3 of Chapter 7B of the GS and Article 6 of Chapter 108A of the GS, or as required by other State or federal law.

EXCEPTION; CARE AND TREATMENT

A consumer is provided a copy of his/her individualized treatment plan upon admission and upon review/update during subsequent Treatment Team/Child and Family Team Meetings. Requests for additional copies will be granted by Medical Records, or an authorized Qualified Professional, when presented in writing utilizing The Ship Group Community Services Care’s Disclosure Form.

The Ship Group Community Services may release confidential information to the referring physician or psychologist.

The Ship Group Community Services may request, receive, and disclose (exchange) confidential information to the extent necessary to enable staff responsible for evaluation, management, supervision, or treatment of individuals examined or committed for outpatient treatment to fulfill their responsibilities.

Any area or State agency or the psychiatric service of the UNC Hospitals at Chapel Hill may share confidential information regarding any client of that agency with any other area or State agency or the psychiatric service of the UNC Hospitals at Chapel Hill when necessary to coordinate appropriate and effective care, treatment or habilitation of the client. For the purposes of this subsection, coordinate means the provision coordination, or management of MH/DD/SAs and related services by one or more agencies and includes the referral of a client 

from one agency to another.

Any State or area agency or the psychiatric service of the UNC Hospitals at Chapel Hill may share confidential information regarding any client of that agency with the Secretary, and the Secretary any share confidential information regarding any client with an area or State agency or the psychiatric service of the UNC Hospitals at Chapel Ill when the responsible professional or the Secretary determines that disclosure is necessary to coordinate appropriate and effective care, treatment or habilitation of the client.

Any area or State agency or the psychiatric service of the UNC Hospitals at Chapel Hill may share confidential information regarding any client of that agency with any other area agency or State agency of the psychiatric service of the UNC Hospitals at Chapel Hill when necessary to conduct payment activities relating to an individual served by the agency. Payment activities are activities undertaken by a agency to obtain or provide reimbursement for the provision of services and may include, but are not limited to, determination of eligibility 

or coverage, coordination of benefits, determination of cost-sharing amounting, claims management, claims processing, claims adjudication, claims appeals, billing and collection activities, medical necessity reviews, utilization management and review, precertification and preauthorization of services, concurrent and retrospective review of services, and appeals related to utilization management and review. An MCO may share confidential information regarding any individual with network providers regarding treatment, payment, and 

healthcare operations.

Whenever there is a reason to believe that a client is eligible for benefits through a Department program, any State or area agency or the psychiatric service of the UNC Hospitals at Chapel Hill may share confidential information regarding any client of that agency with the Secretary, and the Secretary may share confidential information regarding any client with an area agency or State agency or the psychiatric services of the UNC Hospitals at Chapel Hill. Disclosure is limited to that information necessary to establish initial eligibility for benefits, determine continued eligibility over time, and obtain reimbursement for the costs of services provided to the client. 

An area authority or county program may share confidential information regarding any client with any area agency, and any area agency may share confidential information regarding any client of that agency with the area authority or county program, when the area authority or county program determines the disclosure is necessary to develop, manage, monitor, or evaluate the area authority's or county program's network of qualified providers as provided in GS 122C-115.2(b)(1), G.S. 122C-141(a), the State Plan, and rules of the Secretary. For the purposes of this subsection, the purposes or activities for which confidential information may be disclosed include, but are not limited to, quality assessment and improvement activities, provider accreditation and staff credentialing, developing contacts and negotiating rates, investigating and responding to client grievances and complaints, evaluating practitioner and provider performance, auditing functions, on-site mentoring, conducting consumer satisfaction studies, and collecting and analyzing performance data.

Any area agency may share confidential information with any other area agency regarding an applicant when necessary to determine whether the applicant is eligible for area agency services. An agency, physician, or other individual responsible for evaluation, management, supervision, or treatment of respondents examined or  committed for outpatient treatment under the provisions of Article 5 of this Chapter may request, receive, and disclose confidential information to the extent necessary to enable them to fulfill their responsibilities.

An agency may furnish confidential information in its possession to the Dept. of Correction when requested by that dept. regarding any client of that agency when the inmate has been determined by the DOC to be in need of treatment for MI, DD or SA. The DOC may furnish to an agency confidential information in its possession about treatment for MH, DD, or SA that DOC has provided to any present or former inmate if the inmate has been involuntarily committed to the requesting agency for inpatient or outpatient treatment. Under the circumstances described in this subsection, the consent of the client or inmate shall not be required in order for this information to be furnished and the client or inmate shall furnish the information despite objection. Confidential information disclosed pursuant to this subsection is restricted from further disclosure.

A responsible professional may disclose confidential information when in his opinion there is an imminent danger to the health or safety of the client or another individual or there is a likelihood of the commission of a felony or violent misdemeanor.

A responsible professional may disclose an advance instruction for mental health treatment or confidential information from an advance instruction to a physician, psychologist, or other qualified professional when the responsible professional determines that disclosure is necessary to give effect to or provide treatment in accordance with the advance instruction.

An agency may disclose confidential information to a provider of support services whenever the agency has entered into a written agreement with a person to provide support services and the agreement includes a provision in which the provider of support services acknowledges that in receiving, storing, processing, or otherwise dealing with any confidential information, he will safeguard and not further disclose the information.

Whenever there is a reason to believe that a client is eligible for benefits through a governmental agency, an agency may disclose confidential information to State, local, or federal government agencies. Except as provided in GS 122C (5)(a3), disclosure is limited to that confidential information necessary to establish financial benefits for a client. After establishment of these benefits, the consent of the client or his legally responsible person is required for further release of confidential information under this subsection.

Within an agency, employees, students, consultants or volunteers involved in the care, treatment, or habilitation of a client may exchange confidential information as needed for the purpose of carrying out their responsibility in serving the client.Upon specific request, a responsible professional may release confidential information to a physician or other healthcare provider who is providing emergency medical services to a client. Disclosure of the information is limited to that necessary to meet the emergency as determined by the responsible professional.

Upon request of the next of kin or other family member who has in accordance with G.S. 122C-55(j) through (i) a role in the therapeutic services offered, or other person designated by the client or his legally responsible person, the responsible professional shall provide the next of kin or other family member or the designee with notification of the client's diagnosis, the prognosis, the medications prescribed, the dosage of the medications prescribed, the side effects of the medications prescribed, if any, and the progress of the client, provided that the client or his legally responsible person has consented in writing, or the client has consented orally in the presence of a witness selected by the client, prior to the release of this information. 

Both the client's or the legally responsible person's consent and the release of this information shall be documented in the client's medical record. This consent shall be valid for a specified length of time only and is subject to revocation by the consent individual.

Notwithstanding the provision of GS 122C53(b) or GS 122C-206, upon request of the next of kin or other family member who has a legitimate role in the therapeutic services offered, or other person designated by the client or his legally responsible person, the responsible professional shall provide the next of kin, or family member, or the designee, notification of the client's admission to the agency, transfer to another agency, decision to leave the agency against medical advice, discharge from the agency, and referral sand appointment information for treatment after discharge, after notification to the client that this information as been requested and when determined that the disclosure is in the best interest of the individual. 

In response to a written request of the next of kin or other family member who has a legitimate role in the therapeutic services offered, or other person designated by the client, for additional information not provided for in subsections (j) and (k) of this section, and when such written request identifies the intended use for this information, the responsible professional shall, in a timely manner: (1) Provide the information requested based upon the responsible professional's determination that providing this information will be to the client's therapeutic benefit, and provided that the client or his legally responsible person has consented in writing to the release of the information requested; or 

Refuse to provide the information requested based upon the responsible professional's determination that providing this information will be detrimental to the therapeutic relationship between client and professional; or

Refuse to provide the information requested based upon the responsible professional's determination that the next of kin or family member or designee does not have a legitimate need for the information requested.

EXCEPTIONS; RESEARCH AND PLANNING

The Secretary may require information that does not identify clients from state and area agencies for purposes of preparing statistical reports of activities and services and for planning and study. The Secretary may also receive confidential information from State and area agencies when specifically required by other State or federal law.

The Secretary may have access to confidential information from private or public agencies or agents for purposes of research and evaluation in the areas of MH/DD/SA. No confidential information shall be further disclosed. An agency may disclose confidential information to persons responsible for conducting general research or clinical, financial, or administrative audits if there is a justifiable documented need for this information. A person receiving the information may not directly or indirectly identify any client in any report of the research or audit or otherwise disclose client identify in any way.

RIGHT TO TREATMENT AND CONSENT TO TREATMENT

Each client admitted to and receiving services from an agency has the right to receive age-appropriate treatment for MH/DD/SA illness or disability. Clients have the right to have opportunities that enable them to mature physically, emotionally, intellectually, socially, and vocationally to include special education and training in accordance with state and federal law. Each client, within 30 days of admission to an agency, shall have individual written treatment or habilitation plan implemented by the agency. The client and client's legally responsible person shall be informed in advance of potential risks and alleged benefits of treatment choices.

Each voluntarily admitted client or the client's legally responsible person, or health care agent named pursuant to a valid health care power of attorney has the right to consent to or refuse any treatment offered by the agency.

The person who gave consent may withdraw consent at any time. If treatment is refused, the qualified professional shall determine whether treatment in some other modality is possible. If all appropriate treatment modalities are refused, the voluntarily admitted client may be discharged. In an emergency, a voluntarily admitted client may be administered treatment or medication, other than those specified in subsection (f) of this section, despite refusal of client or client's legally responsible person, or a health care agent named pursuant to a valid health care power of attorney, or the client's refusal expressed in a valid advance instruction for mental health treatment. The Commission may adopt rules to provide a procedure to be followed when a voluntarily admitted client refuses treatment.

Except as provided in G.S. 90-21.4, discharge of a voluntarily admitted minor from treatment shall include notice to and consultation with the minor's legally responsible person and in no event shall a minor be discharged from treatment upon the minor's request alone.

USE OF CORPORAL PUNISHMENT

Corporal punishment may not be inflicted upon any client.