97-H 6238A
Approved Jul. 3, 1997


It is enacted by the General Assembly as follows:

SECTION 1. Chapter 40.1-26 of the general laws entitled "Rights For Persons With Developmental Disabilities" is hereby amended by adding thereto the following sections:

{ADD 40.1-26-4.1. Aversive interventions -- Prohibitions. -- ADD} {ADD It shall be unlawful for any agency to use prohibited aversive intervention techniques on a person with developmental disability in the state of Rhode Island. The specific strategies to be prohibited within the context of behavioral treatment interventions include, but are not limited to the following: ADD}

{ADD (a) noxious, painful, intrusive stimuli or activities that result in pain; ADD}

{ADD (b) any form of noxious, painful or intrusive spray or inhalant; ADD}

{ADD (c) electric shock; ADD}

{ADD (d) water spray to the face; ADD}

{ADD (e) pinches and deep muscle squeezes; ADD}

{ADD (f) shouting, screaming or using a loud, sharp, harsh voice to frighten or threaten or use of obscene language; ADD}

{ADD (g) withholding adequate sleep; ADD}

{ADD (h) withholding adequate shelter or bedding; ADD}

{ADD (i) withholding bathroom facilities; ADD}

{ADD (j) withholding meals, essential nutrition or hydration; ADD}

{ADD (k) removal of an individual's personal property as punishment; ADD}

{ADD (l) unobserved time-out or room/area solely used for time out; ADD}

{ADD (m) facial or auditory screening devices; and ADD}

{ADD (n) use of chemical restraints instead of positive programs or medical treatments. ADD}

{ADD 40.1-26-11. Enforcement. -- ADD} {ADD The Department shall promulgate rules and regulations to carry out the intent of this chapter. ADD}

SECTION 2. Section 40.1-26-2 and 40.1-26-3 of the General Laws in Chapter 40.1-26 entitled "RIGHTS OF PERSONS WITH DEVELOPMENTAL DISABILITIES" is hereby amended to read as follows:

40.1-26-2. Definitions. -- As used in this chapter:

(a) "Participant" means any person eighteen (18) years or older, with a developmental disability who receives services from the division of developmental disabilities and/or an agency licensed by the department of mental health, retardation and hospitals.

(b) "Advocate" means (1) a legal guardian; or (2) an individual acting on behalf of a person with a developmental disability in a manner clearly consistent with the interests of the person with a developmental disability and includes a family member, friend, or professional advocate. Whenever possible an advocate should be selected by the person with a disability.

(c) "Developmental disability" means a severe chronic disability which is attributable to a mental or physical impairment or combination of impairments; is manifested before the person attains age twenty-two (22); is likely to continue indefinitely; results in substantial functional limitations in three (3) or more of the following areas of major life activity: self-care, receptive and expressive language, learning, mobility, self-direction, capacity for independent living, economic self-sufficiency; and reflects the person's need for a combination and sequence of special, interdisciplinary or generic care, treatment, or other services which are of life-long or extended duration and are individually planned and coordinated.

(d) "Department" means the department of mental health, retardation and hospitals.

(e) "Competent" means the ability to understand the likely risks and benefits of a procedure or plan when such risks and benefits are presented to the participant in a manner most likely to be understood by the participant in light of his or her cognitive abilities and learning style.

(f) "Agency" means any person or organization which provides day program services, residential services, support services or advocacy services for persons with developmental disabilities, and which is licensed by the department of mental health, retardation and hospitals pursuant to section 40.1-24-1 et seq.

(g) "Applicant" means any person with a developmental disability who has applied for services from the division of developmental disabilities and/or any agency licensed by the department of mental health, retardation and hospitals pursuant to section 40.1-24-1 et seq.

(h) "Relative" means a member of the participant's or applicant's family who has been actively involved in the participant's or applicant's life, has an ongoing relationship with the participant or applicant, and is supportive in a manner clearly consistent with the best interests of the participant or applicant.

(i) "Individualized plan" means the personalized document which describes an individualized profile of the participant highlighting his or her capabilities, preferences and interests. The plan describes specific supports in the areas of vocational, social, medical, supported living, and rehabilitation required to meet the specific needs of the participant. The plan includes quality indicators that demonstrate the plan has met the expectations of the participant and the participant is satisfied with the support services he or she is receiving.

(j) "Seclusion" means placing a participant alone in a locked room without supervision.

(k) "Serious incidents" means any situation involving a person with developmental disabilities in which the person: (1) has sustained an injury which requires medical care or treatment beyond routine first aid; (2) has been missing; (3) has died; (4) has been involved in a criminal act; (5) has been subject to a medication error.

{ADD (l) "Aversive interventions" means a class of stimuli that are followed by escape of avoidance response.

(m) "Behavioral Treatment Intervention" means any intervention or treatment to develop or strengthen adaptive appropriate behaviors through the application of behavioral interventions and to simultaneously reduce the frequency of maladaptive or appropriate behaviors. Behavior interventions encompass interventions which refer to purposeful, clinical manipulation of behavior. ADD}

40.1-26-3. Participants' rights. -- In addition to any other rights provided by state or federal laws, a participant as defined in this chapter shall be entitled to the following rights:

(a) To be treated with dignity, respect for privacy and have the right to a safe and supportive environment;

(b) To be free from verbal and physical abuse;

(c) To engage in any activity including employment, appropriate to his or her age, and interests in the most integrated community setting.

No participant shall be required to perform labor which involves the essential operation and maintenance of the agency or the regular supervision or care of other participants. Participants may however, be requested to perform labor involving normal housekeeping and home maintenance functions if such responsibilities are documented in the participant's individualized plan;

(d) To participate in the development of his or her individualized plan and to provide informed consent to its implementation or to have an advocate provide informed consent if the participant is not competent to do so;

(e) To have access to his or her individualized plan and other medical, social, financial, vocational, psychiatric or other information included in the file maintained by the agency;

(f) To give written informed consent prior to the imposition of any plan designed to modify behavior, including those which utilize aversive techniques or impairs the participant's liberty or to have an advocate provide written informed consent if the participant is not competent to do so. Provided, however, that if the participant is competent to provide consent but cannot provide written consent, the agency shall accept an alternate form of consent and document in the participant's record how such consent was obtained;

(g) To register a complaint regarding an alleged violation of rights through the grievance procedure delineated in section 40.1-26-5;

(h) To be free from unnecessary restraint. Restraints shall not be employed as punishment, for the convenience of the staff, or as a substitute for an individualized plan. Restraints shall impose the least possible restrictions consistent with their purpose and shall be removed when the emergency ends. Restraints shall not cause physical injury to the participant and shall be designed to allow the greatest possible comfort. Restraints shall be subject to the following conditions:

(1) Physical restraint shall be employed only in emergencies to protect the participant or others from imminent injury or when prescribed by a physician, when necessary, during the conduct of a specific medical or surgical procedure or if necessary for participant protection during the time that a medical condition exists.

(2) Chemical restraint shall only be used when prescribed by a physician in extreme emergencies in which physical restraint is not possible and the harmful effects of the emergency clearly outweigh the potential harmful effects of the chemical restraints.

(3) No participant shall be placed in seclusion.

(4) The agency shall have a written policy that defines the use of restraints, the staff members who may authorize their use, and a mechanism for monitoring and controlling their use.

(5) All orders for restraint as well as the required frequency of staff observation of the participant shall be written.

(i) To have reasonable access to telephone communication;

(j) To receive visitors of a participants choosing at all reasonable hours;

(k) To keep and be allowed to spend a reasonable amount of one's own money;

(l) To be provided advance written notice explaining the reason(s) why the participant is no longer eligible for service from the agency;

(m) To religious freedom and practice;

(n) To communicate by sealed mail or otherwise with persons of one's choosing;

(o) To select and wear one's own clothing and to keep and use one's own personal possessions;

(p) To have reasonable, prompt access to current newspapers, magazines and radio and television programming;

(q) To have opportunities for physical exercise and outdoor recreation;

(r) To provide informed consent prior to the imposition of any invasive medical treatment including any surgical procedure or to have a legal guardian, or in the absence of a legal guardian, a relative as defined in this chapter, provide informed consent if the participant is not competent to do so. Information upon which a participant shall make necessary treatment and/or surgery decisions shall be presented to the participant in a manner consistent with his or her learning style and shall include, but not be limited to:

(a) The nature and consequences of the procedure(s);

(b) The risks, benefits and purpose of the procedure(s); and

(c) Alternate procedures available.

The informed consent of a participant or his or her legal guardian or, in the absence of a legal guardian, a relative as defined in this chapter, may, be withdrawn at any time, with or without cause, prior to treatment. The absence of informed consent notwithstanding, a licensed and qualified physician may render emergency medical care or treatment to any participant who has been injured or who is suffering from an acute illness, disease, or condition if, within a reasonable degree of medical certainty, delay in initiation of emergency medical care or treatment would endanger the health of the participant;

(s) Each participant shall have a central record. The record shall include data pertaining to admissions and such other information as may be required under regulations by the department;

(t) Admissions -- As part of the procedure for the admission of a participant to an agency, each participant or applicant, or advocate if the participant or applicant is not competent, shall be fully informed orally and in writing of all rules, regulations and policies governing participant conduct and responsibilities, including grounds for dismissal, procedures for discharge, and all anticipated financial charges, including all costs not covered under federal and/or state programs, by other third party payors or by the agency's basic per diem rate. Such written notice shall include information regarding the participant's or applicant's right to appeal the admission or dismissal decisions of the agency;

(u) Upon termination of services to or death of a participant, a final accounting shall be made of all personal effects and/or money belonging to the participant held by the agency. All such personal effects and/or money including interest shall be promptly released to the participant or his or her heirs.

{ADD (v) Nothing in this chapter shall preclude intervention in the form of appropriate and reasonable restraint should it be necessary to protect individuals from physical injury to themselves or others. ADD}

SECTION 3. This act shall take effect upon passage.

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