Title 7 . Health and Social Services

Chapter 12 . Assistance for Community Health Facilities

Section 215. Psychiatric hospitals

7 AAC 12.215. Psychiatric hospitals

(a) A hospital which is primarily engaged in providing to inpatients psychiatric services for the diagnosis and treatment of mental illness is a psychiatric hospital and must comply with the provisions of this section.

(b) A psychiatric hospital must have the following minimum staff and on-site services, in addition to those required by 7 AAC 12.205:

(1) a medical service, supervised by a physician;

(2) a psychiatric service, supervised by a psychiatrist;

(3) a psychological service, which includes one or more psychologists employed on a full-time, regular part-time, or consulting basis;

(4) a social work service which includes one or more social workers employed on a full-time, part-time or consulting basis, under the direction of the medical staff;

(5) a nursing service, under the direction of a registered nurse who has the following qualifications:

(A) a master's degree in psychiatric nursing or a related field with one year of experience in nursing administration; or

(B) a baccalaureate degree in nursing with 2 years of experience in psychiatric nursing and two years of experience in nursing administration; and

(6) sufficient registered nursing personnel to give direct nursing care, and to plan, supervise, and coordinate care given by other mental health workers.

(c) In addition to the services listed in (b) of this section, a psychiatric hospital must provide the following services, either directly or through a contract with outside providers:

(1) psychological testing and counseling;

(2) assessment, screening and diagnostic services;

(3) individual psychotherapy;

(4) group therapy;

(5) family therapy; and

(6) therapeutic occupational and activity programs.

(d) A psychiatric hospital must have policies and procedures which require that it

(1) have a transfer agreement with a general acute care hospital which includes provision for transfer of a patient's records upon transfer of the patient;

(2) admit and discharge patients in accordance with AS 47.30;

(3) provide for each patient a written treatment plan, developed with the patient's participation as far as practicable, which incorporates a comprehensive interdisciplinary approach based on the patient's medical, social, and psychiatric or psychological evaluations;

(4) include as part of each patient's evaluation

(A) a medical history;

(B) a history of the current onset of illness, including the circumstances leading to admission;

(C) a description of the patient's current mental status, including attitudes, behavior, intellectual and memory functioning, and orientation;

(D) a descriptive inventory of the patient's assets; and

(E) if the patient is a child or adolescent, a report on the patient's developmental as well as chronological age;

(5) provide organized therapeutic activities with consideration for the interests and needs of the patients;

(6) document in each patient's medical record the patient's attitude and response to treatment;

(7) establish and implement guidelines for use of physical restraints and seclusion rooms which include the following requirements:

(A) the location of a seclusion room which allows for direct supervision and observation by staff;

(B) construction of a seclusion room which minimizes opportunity for concealment, escape, injury, or suicide, including locks and doors which open outwards;

(C) recording in a patient's medical record the time the patient spent in seclusion or restraints;

(D) visiting a patient who is in restraints or seclusion at least hourly, and providing the patient with adequate opportunity for exercise, access to bathroom facilities, and time out of restraints or seclusion;

(E) limiting the use of restraints or seclusion to situations in which alternative means will not protect the patient or others from injury; and

(F) when practicable, consultation with the patient regarding the patient's preference among available forms of adequate, medically advisable restraints, including medication;

(8) establish and implement guidelines for administration of a drug when given in an unusually high dose or when given for a purpose other than that for which the drug is customarily used, and for circumstances under which electroconvulsive shock therapy may be administered;

(9) provide that each treatment unit within the hospital keeps a confidential log of all referrals it initiates or receives;

(10) provide an area in which a patient can meet with an outside community service provider and other hospital personnel who assist in fulfilling the goals and objectives of the treatment plan;

(11) have a committee of the medical staff periodically evaluate the services provided and make appropriate recommendations to the medical staff and administration; and

(12) establish and implement

(A) controls for contraband;

(B) security controls and management for potentially dangerous individuals, and for patients committed before October 1, 1982 under AS 12.45 and after September 30, 1982 under AS 12.47;

(C) preventive measures for suicide or self-harm;

(D) admission criteria for a psychiatric security unit; and

(E) controls for storage and handling of police officers' weapons.

(e) If a psychiatric hospital permits human subject research, it must

(1) have written policies which describe the purpose and conduct of all research using the hospital's staff, patients, or services, and which require that

(A) written agreements entered into by subjects do not include exculpatory language through which the subject waives any legal rights or which releases the hospital or its staff from liability for negligence;

(B) when research findings are made public, the anonymity of individual patients is assured; and

(C) when bodily integrity is violated, including by the use of electroconvulsive shock therapy and chemotherapy, supervision be provided by a physician; and

(2) establish an interdisciplinary review committee comprised of both hospital staff members and other knowledgeable persons, for the purpose of reviewing research activities within the facility.

(f) If a psychiatric hospital provides aftercare service, that service must include a written individualized treatment plan designed to establish continuing contact for the care of each patient and explain the risks, benefits, and side effects of medication programs to the patient.

(g) A psychiatric hospital must provide for educational or training programs for all children of school age who are educable or trainable and who are expected to be patients for longer than one month. The programs must

(1) conform to educational requirements established by law and be under direction of teachers certified to teach in Alaska; and

(2) if provided by a public school system, include provisions for transportation of the patients to and from school and supervision of them during the transportation.

History: Eff. 11/19/83, Register 88

Authority: AS 18.20.010

AS 18.20.060