OAR 333-505-0033: Patient Rights

(1) A hospital shall comply with the requirements for patients' rights as set forth in 42 CFR 482.13. (2) As used in sections (3) through (9) of this rule: (a) "Patient" means a patient admitted to a hospital or seeking medical evaluation and care in an emergency department who needs assistance to effectively communicate with hospital staff, make health care decisions, understand health care information, or engage in activities of daily living due to a disability, including but not limited to: (A) A physical, intellectual, behavioral or cognitive impairment; (B) Deafness, being hard of hearing or other communication barrier; (C) Blindness; (D) Autism; or (E) Dementia; (b) "Support care conference" means a meeting in person, by telephone, or electronic media, that includes a representative from the patient's hospital care team, the patient, the patient's legal representative (if applicable), and the patient's designated support person(s). The support care conference must include discussion of denial and any parameters for permitting a support person to be physically present with the patient including but not limited to any limitations, restrictions, or additional precautions that may be implemented for the safety of the patient, support person, and hospital staff. (c) "Support person" means a family member, guardian, personal care assistant or other paid or unpaid attendant selected by the patient to physically or emotionally assist the patient or ensure effective communication with the patient. (3) A patient has the right, and a hospital must allow a patient, to designate at least three support persons and to have at least one support person physically present with the patient at all times in the emergency department and during the patient's stay at the hospital if necessary to facilitate the patient's care including but not limited to when the patient: (a) Has a cognitive, intellectual or mental health disability that affects the patient’s ability to make or communicate medical decisions or understand medical advice; (b) Needs assistance with activities of daily living and the hospital staff are unable to provide the same level of care or are less effective at providing the assistance; (c) Is deaf, is hard of hearing or has other communication barriers and requires the assistance of a support person to ensure effective communication with hospital staff; or (d) Has behavioral health needs that the support person can address more effectively than the hospital staff. (4) Unless a patient requests otherwise, a hospital must ensure that a support person designated by the patient, or patient's legal representative, is physically present for any discussion in which the patient is asked to: (a) Elect hospice care; (b) Sign an advance directive; or (c) Sign any other document allowing the withholding or withdrawing of life-sustaining procedures or artificially administered nutrition or hydration. (5) A hospital shall develop and implement a policy regarding a patient's rights and the hospital's obligations in sections (3) and (4) of this rule. The policy shall recognize at a minimum: (a) The notification requirements described in sections (6) and (7) of this rule; (b) That either the patient or a patient's legal representative in collaboration with the patient, may designate support persons; (c) That the hospital shall post the hospital's policy on its website and post a summary of the policy, with instructions on how to obtain the full policy, at entry points to the hospital. The posting at each entry shall be clearly visible to the public and the full policy will include contact information for a person, position, or a department at the hospital where the policy may be requested in an alternate format; and (d) That the hospital may not condition the provision of treatment to a patient in accordance with ORS 441.048. (6) A hospital shall provide all patients orally and in writing notice of their right to support persons as described in section (3) of this rule. In addition: (a) Notice to patients shall include that treatment cannot be conditioned upon having an advance directive, POLST, or an order withdrawing or withholding life support such as a Do Not Resuscitate order. (b) Notice must be made available in alternate formats at the request of the patient or the patient's legal representative. (7) As specified in section (3) of this rule, a hospital must allow at least one support person to be physically present with a patient at all times in the emergency department and during the patient's stay at the hospital. This includes, but is not limited to, an operating room, a procedure room, or other area where generally only patients and hospital staff are allowed. (a) Consistent with other state and federal requirements, a hospital may impose conditions for any support person(s) present at the hospital to ensure the safety of the patient, support person(s) and staff as specified in ORS 441.049. (b) If a hospital denies a patient's request for a support person's physical presence with the patient, or a portion of such a request, the hospital shall: (A) Immediately notify the patient and the patient's designated support person(s) orally and in writing of the opportunity to request a support care conference to discuss the denial and any parameters for permitting a support person to be physically present. (B) Upon request for a support care conference, conduct a support care conference as soon as possible but not later than 24 hours after admission or prior to a procedure or operation. (C) Following a support care conference, the hospital shall document the decision and any reasons for the limitation, restriction, additional precautions or prohibition in the treatment plan. If a support care conference does not occur, the hospital shall document in the treatment plan why the support care conference did not occur. (8)(a) A hospital may refuse to allow the presence of a designated support person who refuses or fails to comply with conditions imposed by the hospital or remove a designated support person from a procedure room, operating room, or other area where generally only patients and hospital staff are allowed, if necessary to ensure the safety of the patient, support person or staff. (b) The hospital shall ensure that another designated support person is permitted to be physically present with the patient if otherwise consistent with this rule. (9) If a patient, or a patient's legal representative does not designate a support person(s) and a hospital determines that a patient has a communication barrier or other disability, the hospital shall take reasonable steps to further communicate the patient's right to support persons to the patient, patient's family or patient's legal representative. (10) A hospital shall provide health care interpretive services to a patient who prefers to communicate in a language other than English in accordance with ORS 413.559 and OAR 950-050-0160.