 |
D.C. Municipal Regulations (Last Updated: September 13, 2017) |
 |
Title 22. HEALTH |
|
SubTilte 22-A. MENTAL HEALTH |
|
Chapter 22-A5. USE OF RESTRAINTS AND SECLUSION |
Section 22-A599. DEFINITIONS
-
"Assertive community treatment or "ACT" - intensive, integrated rehabilitative, crisis, treatment, and community support provided to adult consumers with serious and persistent mental illness by an interdisciplinary team, in accordance with the requirements of 22-A DCMR Chapter 34.
"Assertive Community Treatment team" or "ACT team" - the mobile inter-disciplinary team of qualified practitioners and other staff involved in providing ACT to a consumer.
"Attending physician" - the physician on duty or on call at the MH provider at the time an emergency requiring the use of restraints/seclusion occurs. In some instances, the attending physician may also be the consumer's treating physician.
"Cardiopulmonary resuscitation" - an emergency technique to revive somebody whose heart has stopped beating that involves clearing the person's airways and then alternating heart compression with mouth-to-mouth respiration.
"Consumer" - an adult, child, or youth who seeks or receives mental health services or mental health supports in the District of Columbia under Chapter 5 of Title 21 of the District of Columbia Code, or Chapter 5 of Title 24 of the District of Columbia Code, regardless of whether the person's status is voluntary, non- protesting, or involuntary.
"Consumer statement of treatment preferences" - a document or form completed by a consumer in accordance with District of Columbia Official Code § 7-1231.01 that indicates the consumer's preferences regarding the use of seclusion or restraints and less restrictive alternatives to be used or attempted in a psychiatric emergency situation. A consumer statement of treatment preferences may be contained in either a Declaration of Advance Instructions or Durable Power of Attorney for Healthcare.
"Core services agency" - a DMH-certified community-based provider of mental health rehabilitation services that has entered into a Human Care Agreement with DMH to provide specified services and serves as the clinical home for consumers enrolled in and eligible to receive mental health rehabilitation services.
"DMH" - the Department of Mental Health, the successor in interest to the District of Columbia Commission on Mental Health Services.
"Emergency" - a situation in which a consumer is experiencing a mental health crisis and is presenting an imminent risk of serious injury to self or others.
"Forensic services" - the program operated by DMH at Saint Elizabeths Hospital that provides court-ordered and legally mandated mental health services to persons who are involved in the criminal justice system and require inpatient pretrial examination and treatment; inpatient hospitalization and treatment due to a verdict of not guilty by reason of insanity and inpatient hospitalization while serving a prison sentence.
"Inpatient mental health service" - residence and treatment provided in a psychiatric hospital or unit, which is licensed or operated by the Mayor.
"Maximum security consumers" - those persons who have been committed to either DMH or Saint Elizabeths Hospital by the Criminal Division of the local or federal courts or the Department of Corrections and who reside on a maximum security unit within the forensic services program.
"Mayor" - means the Mayor of the District of Columbia or any executive branch agency the Mayor may designate for purposes of this chapter.
"Mental health provider" or "MH Provider" - any entity that is (1) operated, licensed, or certified by the Mayor to provide mental health services or mental health supports; or (2) that has entered into an agreement with the Mayor to provide mental health services or mental health supports.
"Physical hold" - the application of physical force without the use of any mechanical device, for the purpose of restraining the free movement of a consumer's body.
"Physician" - a person licensed under the laws of the District of Columbia to practice medicine, or a person who practices medicine in the employment of the government of the United States.
"Physician assistant" - a health professional who meets the qualifications for licensure as a physician assistant by the District of Columbia Board of Medicine and who is licensed in the District of Columbia as a physician assistant, or a person who practices as a physician assistant in the employment of the government of the United States.
"Registered nurse" or "RN" - a person licensed as a registered nurse in accordance with applicable District of Columbia laws and regulations or a person who practices nursing in the employment of the government of the United States.
"Restraints" - a physical restraint or a drug that is used for the purpose of restraint. Restraints do not include a physical hold of fifteen (15) minutes or less in duration.
"Seclusion" - any confinement of a consumer alone in a room or an area which the consumer is either physically prevented from leaving or from which the consumer is led to believe he or she cannot leave at will.
"Serious injury" - any significant impairment of the physical or mental condition of a person, as determined by qualified medical personnel. This includes, but is not limited to, burns, lacerations, bone fractures, substantial hematoma, and injuries to internal organs, whether self-inflicted or inflicted by someone else, as well as emotional trauma requiring specific services and supports in addition to or beyond those mental health services and supports already being received by the person.
"Service plan" - the individualized recovery plan for adults or the individualized plan of care for children/youth, which includes the consumer's treatment goals, strengths, challenges, objectives, and interventions.
"Site-based crisis emergency provider" - an MH provider certified by DMH to provide crisis emergency services in accordance with 22-A DCMR 3419 and provides crisis emergency services pursuant to the terms of a human care agreement with DMH. The modifier, "site-based" refers specifically to those services provided in the physical facility of the crisis emergency provider (in contrast to its community-based, outreach services). A site-based crisis emergency provider must have the ability to provide psychiatric emergency treatment including the continuous availability of an on-site or on-call psychiatrist, the continuous availability of a formulary of psychotropic medications, nursing staff continually available to give emergency orders for the use of restraints and the appropriate equipment.
"Staff" - those individuals with responsibility for managing a person's health care or participating in an emergency and who are employed by the MH provider on a full-time, part-time, or contract basis, including without limitation physicians, nurses, orderlies, resident physicians, interns, and direct care workers.
"Treating physician" - the physician, who may be a psychiatrist, responsible for the regular and ongoing mental health treatment of the consumer. In some instances, the consumer's treating physician may also be the attending physician.