About Us: Patient Rights & Responsibilities

Altoona Regional Health System respects and supports the basic human, civil, constitutional and statutory rights of patients. Altoona Regional Health System provides care, treatment and services to patients within its capability and mission, and in compliance with law and regulation.

The safety of health care delivery is enhanced when patients, as appropriate, are partners in the health care process. Patients and their families, therefore, have responsibilities when they are utilizing the hospital’s services. Attached is a copy of Altoona Regional Health System’s “Patient Rights & Responsibilities,” which is provided to all inpatients and outpatients at Altoona Regional Health System to advise them of their rights and responsibilities as our patients. This is reviewed and updated yearly or as necessary to protect those rights and responsibilities.

Altoona Regional Health System is an integrated health care delivery system that helps to ensure that our patients’ total needs are met across the continuum of care. This health care delivery system includes traditional inpatient and outpatient hospital services currently provided at the Altoona Hospital Campus. Outpatient Surgery is provided in the Ambulatory Surgery Center, located on the Altoona Hospital Campus. Various outpatient services, to include imaging, physical medicine, laboratory, sleep lab, neurology, cardiac rehab, surgical pre-testing and HealthForce (occupational medicine), are located off-site at the Station Medical Center. Home nursing care is provided by our corporate affiliate, Home Nursing Agency, through a subsidiary located off campus. Durable home medical equipment is provided through our subsidiary, Home Health Resources, and outpatient pharmacy services are provided by our subsidiary, Kopp Pharmacy, both of which are located off campus. Inpatient rehabilitation services are provided via a joint venture with HealthSouth.

Patients who understand and participate in their health care usually achieve better outcomes. Altoona Regional Health System is committed to providing you, our patient, with high-quality medical care. The hospital’s vision and values give rise to our mission. We are guided by our Ethical Standards.

The hospital will follow all laws and regulations with respect to your rights as a patient. Patient rights are based on mutual trust and respect between patient and caregiver. If you are receiving mental health care at the hospital, there are additional rights that are afforded to you, and this department will provide information to you concerning those specific rights.

As a patient, you are entitled to be informed of your rights while receiving care at Altoona Regional Health System. Included in this brochure is a statement on Privacy and Confidentiality. It explains your rights and responsibilities. In addition, Altoona Regional Health System will provide you with our Notice of Privacy Practices to further explain your privacy rights and how your health information will be used. This information is provided to you upon each admission and outpatient service.

Privacy and Confidentiality

Every patient, regardless of age, retains certain rights to privacy. Thus, case discussion, consultation, examination and treatment are considered confidential and should be conducted discreetly. Assessments, consultations, examinations and treatments of newborn or pediatric patients are conducted as discreetly as possible and in a manner designed to respect the privacy of both the parent and the child.

We recognize that medical information about our patients is personal. We are committed to maintaining the privacy of the medical information that we create, receive and maintain on behalf of our patients. We use patient health information for routine treatment, payment and operational purposes. For most other uses of patient health information, we will obtain the patient’s written authorization prior to releasing information. Please refer to our Notice of Privacy Practices for more detailed information on our privacy practices and the rights that you have concerning your health information. A Notice should have been provided to you upon admission. If it was not, or you need another copy, please request it from a staff member, and they will be able to obtain a copy for you.

Information

Patients are entitled to effective communication with their health care team members. Patients are entitled to be informed of their medical condition in a timely manner as appropriate to their medical condition, including diagnosis, prognosis, proposed treatment, alternate modes of treatment, possible complications, possible results if the patient decides not to be treated and unanticipated outcomes. If it is not feasible to give such information to you, the information will be given to your authorized decision maker. This is especially true when the patient does not have the mental or physical capacity to make care decisions, or when the patient is a child. When the patient cannot make decisions regarding his or her care, an authorized decision maker is identified, which may be a family member, broadly defined to include friends and same-sex partners. In the case of an unemancipated minor, the parent or legal guardian is responsible for consenting to the care prescribed. The patient has the right to exclude any or all family members from participating in his or her care decisions.

The hospital will provide to parents access to all information contained in their child’s medical record, unless access is specifically restricted by the attending physician for medical reasons or the access is otherwise prohibited by law.

Patients, the patient’s family/authorized decision maker (if appropriate) and parents in the case of newborn and pediatric patients are also entitled:

1. To know the names of your attending physician, other physicians directly participating in your care, reasons for any proposed changes in the professional staff responsible for your care and the names of and functions of other health care persons having direct contact with you.
2. To have a family member or representative of your choice and your own physician notified promptly of your admission to the hospital.
3. To identify a support person whose presence may relieve your stress and provide emotional support, with the understanding that the support person’s presence may be limited if it infringes on others’ rights, compromises safety or is medically or therapeutically contraindicated.
4. To know what rules and regulations of Altoona Regional Health System apply to your conduct as a patient.
5. Except in a medical emergency, to give informed consent prior to the start of any procedure or treatment, unless this would have a seriously adverse effect on you.
6. To give informed consent prior to participation in any medical care, research program or donor program. If the patient is unable to give informed consent, an authorized decision maker may act on the patient’s behalf. A patient or authorized decision maker on behalf of a patient may refuse to continue in any such program or research to which he or she has previously given informed consent. Refusal to continue in the research program will not compromise access to care, treatment and services.
7. To access the Ethics Committee to resolve patient dilemmas regarding withholding resuscitative services, foregoing/withdrawing life-sustaining treatment or issues regarding care at the end of life, etc. Access to the Ethics Committee may be accomplished by a request to the attending physician or to a member of the nursing staff.
8. To assistance in obtaining consultation with another physician at your request and expense.
9. To the assistance of an interpreter if you do not speak English or to a sign language interpreter if you are hearing impaired as a free service to ensure your safety or to special devices to assist with mobility issues.
10. To obtain, upon written request, information contained in your medical records to the extent that the requested access is legally permissible.
11. To make a written request for an amendment to your medical records and/or an accounting of disclosures regarding your own health information as further explained in the Altoona Regional Health System Notice of Privacy Practices provided to you upon admission.
12. To examine and receive a detailed explanation of your bill and to information and counseling about the availability of financial resources for your health care.
13. To be informed of the source of the hospital’s reimbursement for his/her services, and of any limitations which may be placed upon his/her care.
14. To have explained by the responsible licensed independent practitioner or his or her designee the results of any treatments or procedures that differ significantly from the anticipated results.
15. To be informed, upon your discharge, of any continuing health care requirements following your discharge, as well as the means for meeting those requirements.
16. To access protective services (i.e., guardianship and advocacy services, child or adult protective services, etc.).
17. To be free from unnecessary use of physical or chemical restraint and/or seclusion as a means of coercion, convenience or retaliation. Restraints and/or seclusion will be used when clinically necessary.
18. To receive care in a safe setting, free from mental, sexual, verbal or physical abuse, harassment, neglect or exploitation.
19. To appropriate assessment and management of pain and to receive information and to expect timely staff response to reports of pain.
20. To expect the hospital to get your permission when photographing, filming or recording you, if the purpose is for something other than patient identification, care, diagnosis or therapy.
21. To be informed of your visitation rights, including any clinical restriction or limitation on such rights.
22. To be informed of the right, subject to your consent, to receive the visitors whom you designate, including, but not limited to, a spouse, a domestic partner (including a same-sex domestic partner), another family member or a friend, and your right to withdraw or deny such consent at any time.
23. To not be restricted, limited or otherwise denied visitation privileges on the basis of race, color, national origin, religion, sex, gender identity, sexual orientation or disability.
24. To ensure that all visitors enjoy full and equal visitation privileges consistent with your preferences.

Participation

As a patient, the patient’s authorized decision maker (if appropriate) or parent in the case of newborn and pediatric patients, you are entitled:

1. A. To the opportunity to participate in planning your treatment. You are entitled to refuse drugs, medical/surgical treatment or procedures, including foregoing or withdrawing life-sustaining treatment or withholding resuscitative services, to the extent permitted by law, and to be informed of the medical consequences of this refusal.
2. To be transferred or discharged only for medical reasons, for your own welfare or that of other patients, or when it is deemed that acute care is no longer needed, and to be given advance notice and complete information to ensure orderly transfer or discharge. In the case of a transfer, you or your authorized decision maker are entitled to information concerning the needs for and alternatives to transfer. The institution to which you are to be transferred must first have accepted you for transfer.

Competent adults have the right to formulate advance directives and submit them to the hospital. The definition of an advance directive is “a written instruction, such as a living will or health care power of attorney, recognized under state law (whether statutory or as recognized by the courts of the state) and relating to the provision of such care when the individual is incapacitated.” The Commonwealth of Pennsylvania has a statute governing living wills, and a durable power of attorney statute, which includes health care decision making.

The hospital, through its Case Management Department, provides information to patients who do not have an advance directive but may wish to formulate one. If you provide a copy of your advance directive to the hospital, it will be maintained with your medical record for each current admission. We will do our best to honor your wishes.

You may file a complaint with the state survey and certification agency if you believe the hospital has not complied with this advance directive requirement.

Respect and Dignity

Patients of all ages are entitled to be treated by competent personnel with consideration, respect and recognition of your individuality and personal needs.

The patient, the patient’s family and/or parent of a newborn or pediatric patient has the right to support services and an environment which will assist in meeting his/her social, emotional and spiritual needs during illness.

Patients who desire private telephone conversations have access to space and telephones appropriate to their needs and the care, treatment and services provided.

If it is necessary to restrict a patient’s access to communication (visitors, mail, telephone calls or other forms of communication) as a component of a patient’s care in order to prevent injury or deterioration in their health, infringement on the rights of others, etc., the patient or the patient’s authorized decision maker (if appropriate) will be included in any such decision.

Quality Care

You have the right to medically appropriate services without discrimination based on race, ethnicity, age, religion, culture, language, physical or mental disability, socioeconomic status, sex, sexual orientation and gender identity or expression. A patient is entitled to quality care and high professional standards, which are continually maintained and reviewed. Decisions regarding the provision of ongoing care, treatment, services or discharge are based on the care, treatment and services required by the patient.

In addition, you may expect good management within Altoona Regional Health System that is concerned with your comfort and convenience. You may expect emergency procedures to be implemented without unnecessary delay.

However, scheduling of procedures and treatment of patients in an emergency setting will be prioritized by medical need rather than by time of arrival. Scheduling of non-emergency procedures, including surgery, is designed to maximize efficient delivery of care and may necessarily involve delay for some patients. Every effort will be made to avoid inconveniencing our patients.

Physician Rights

While the hospital has an open admission policy, it acknowledges that physician members of the staff are independent practitioners who may decide not to accept a non-emergent/elective patient, subject, however, to requirements of the Medical Staff Rules & Regulations, Section V, Subsections 5.5. and 5.6, which state:

“5.5 All physicians who are scheduled to be available on call to provide services to unassigned patients in the Emergency Department shall accept all patients coming to the Emergency Department who are determined to need the services of the on-call physician, regardless of the patient’s race, color, creed, national origin, gender, religion, ability to pay or third-party payer involved.

“5.6 It is the responsibility of any physician on the on-call schedule to either be personally available to evaluate and treat patients when scheduled or to arrange for coverage by another physician who is a member of the medical staff with appropriate clinical privileges…”

Grievance Mechanism

Patients, the patient’s family and parents in the case of newborn and pediatric patients are encouraged to share a grievance (i.e., injury, injustice or wrong that gives grounds for a complaint) with a member of Altoona Regional Health System’s staff or an agency or regulatory body with jurisdiction over the hospital or through a representative of your choice, without being subjected to coercion, discrimination, reprisal or unreasonable interruption of care, treatment and services.

The individual may submit a written or verbal grievance to the president/ CEO of the hospital or individual in charge of the area wherein the grievance initiates. An acknowledgment letter will be sent by the hospital staff member who receives the grievance within seven working days to the patient/family member. A written response will be provided the patient/family member, along with the name of the hospital contact person, the steps taken on behalf of the patient to investigate the grievance, the results of the grievance process and the date of completion. If the situation is not resolved within the seven days, then the acknowledgment letter will advise the complainant that a final written resolution letter outlining the steps taken to resolve the issue will be sent within thirty days. If the complainant files a grievance regarding care provided by Behavioral Health Services, then the grievance and appeal mechanisms outlined in the Behavioral Health Services’ departmental Standard of Practice will be adhered to.

In the event that the patient/family member wishes, they have the right to lodge a grievance with the appropriate state survey agency:

Health Facility Quality Examiner
Division of Acute & Ambulatory Care
Johnstown Field Office
184 Donald Lane, Suite 2
Johnstown, PA 15904
814.248.3129
Central Hotline # 1.800.254.5164

In the event that the patient/family has any concerns about patient care and safety in the hospital that have not been addressed by hospital management, he or she is encouraged to contact The Joint Commission Office of Quality Monitoring as follows:
1.800.994.6610
via e-mail: complaint@jointcommission.org

Responsibilities

1. Patients, the patient’s family and parents in the case of newborn and pediatric patients are responsible for being considerate of other patients by:
   1. Ensuring a roommate’s privacy.
   2. Limiting your visitors to three at a time during specified visiting hours.
   3. Reminding visitors to maintain a quiet atmosphere and observe smoke-free regulations.
   4. Using television, telephone, radio and lights in a manner that is not disturbing to others.
   5. Refraining from abusive and profane language.
2. Patients, the patient’s authorized decision maker (if appropriate) and parents in the case of newborn and pediatric patients are responsible for supplying accurate and complete information about past illnesses, hospitalizations, medications and other matters relating to your health. This includes informing your physician and/or nurse of any pain (new onset or pre-existing) and helping with the pain assessment. Also necessary is the discussion of pain relief options with your physician and/or nurse.
3. Patients, the patient’s authorized decision maker (if appropriate) and parents in the case of newborn and pediatric patients are responsible for notifying your doctor or nurse about any unexpected change in your health problems or perceived risks in your care and asking questions about your health problems and related care.
4. Patients, the patient’s authorized decision maker (if appropriate) and parents in the case of newborn and pediatric patients are responsible for following instructions and letting us know immediately if you do not understand instructions or if you feel that they are such that you cannot follow them.
5. Patients, the patient’s authorized decision maker (if appropriate) and parents in the case of newborn and pediatric patients accept responsibility for the outcomes if you do not follow the treatment plan/instructions of a practitioner/physician.
6. Patients, the patient’s authorized decision maker (if appropriate) and parents in the case of newborn and pediatric patients are responsible for:
   1. Asking questions if you are concerned about your health or safety.
   2. Asking all hospital staff to identify themselves.
   3. Reminding staff to check your identification before medications are given, blood/blood products are administered, blood samples are taken or any procedure is carried out.
   4. Reminding caregivers to wash their hands before taking care of you.
   5. Being informed about which medications you are taking and why you are taking them.
   6. Reminding your doctor of the site/side of the body that will be operated on before a procedure.
7. Patients, the patient’s authorized decision maker (if appropriate) and parents in the case of newborn and pediatric patients are responsible for fulfilling the financial obligations of your health care promptly.
8. Patients, the patient’s authorized decision maker (if appropriate) and parents in the case of newborn and pediatric patients are responsible for using hospital supplies appropriately to assist in assuring their availability for future patients. You are also expected to be respectful of the property of other persons and the property of the hospital and following the rules and regulations of the hospital.