Community Grievance Decision Digest

RISK REDUCTION MEASURES

The decision summaries regarding this law may be found in the document:
Community Grievance Decision Digest: Decisions. (PDF, 512KB)

THE LAW:

Each patient shall... "Have a right to a humane psychological... environment within the hospital facilities..."

ss. 51.61(1)(m), Wis. Stats. [Emphasis added.]

“Patients have the right to be free from having arbitrary decisions made about them. To be non-arbitrary, a decision about a client must be rationally based upon a legitimate treatment, management or security interest.” 

DHS 94.24(3)(h), Wis. Admin. Code [Emphasis added.]

Standard for Risk-Reduction Measures:

When a decision is made to take an action to prevent a patient from being in the position to impose a significant risk of harm, this is a risk reduction measure.  In accordance with the Client Rights Office, risk-reduction measures must meet the following standards in order not to be found to be arbitrary:

1.      There must be a showing that there is a significant risk that the patient will exhibit the feared behavior.

[This is analogous to the “probable cause” standard used in the legal system.]

2.      There must be a rational basis for the perception that there is a risk.

[Staff should take into account all available evidence and should be as free from personal bias as possible. Staff may, however, rely on their subjective or intuitive skills if necessary to reach a judgment. The patient’s past history, especially with regard to antecedent behaviors, can play a key role in arriving at the perception that there is a risk.]

3.      The measure taken to reduce the risk should be the least restrictive alternative that is appropriate to the danger. 

[The measure taken must actually reduce the risk.  If it does not reduce the risk, what is the point? No measure should be taken which is more restrictive than necessary to accomplish the goal.]

4.      The measures must be ended as soon as the danger is over. 

[The danger is the justification. When the risk has been reduced to an acceptable level, the justification no longer exits. That is why patients must be removed from seclusion and/or restraint when they have calmed down. Trial releases from seclusion and/or restraint are one way to measure the current level of risk.]

5.   The measures must meet the basic standards for humane treatment.

NOTE: Imposition of a consequence for violation of a rule is a deterrent sanction and must meet deterrent standards. See Rules & Sanctions section of this digest.

DECISIONS:

[None at this time.]

Last Updated: June 18, 2009