DMHAS Grievance Process Flyer
WHICH PROVIDERS AND SERVICES ARE COVERED BY THE PROCESS?
The grievance process applies to all DMHAS facilities that provide direct mental health services. It also applies to agencies that provide direct mental health services under a contract with DMHAS for services funded partially or in full by DMHAS. However, DMHAS may exempt a contract agency if DMHAS funding for the program is not more than 20% of its budget and the program has another procedure to resolve the grievance. In addition, this procedure does not apply to matters within the exclusive jurisdiction of the Psychiatric Security Review Board.
WHAT ACTIONS ARE COVERED BY A GRIEVANCE?
A grievance can be filed when a client believes that a staff member or agency has treated a client in an arbitrary or unreasonable manner; denied, involuntarily reduced or terminated services or failed to provide services authorized by a treatment plan due to negligence, discrimination or other improper reason; engaged in coercion to improperly limit a client’s choice; unreasonably failed to intervene to protect one client whose rights are jeopardized by another client; violated other individual rights granted to clients by statute regulation or DMHAS directive.
WHO MAY FILE A GRIEVANCE?
A grievance may be filed by a client, or if he or she is unable to do so, by a person designated by the client, or a person authorized by law or by the Commissioner to act on the client’s behalf.
Legal advocates who work for the Connecticut Legal Rights Project are available to assist, and when appropriate, represent DMHAS clients filing grievances.
WHEN MUST A GRIEVANCE BE FILED?
A grievance must be filed within forty-five days of the action that is the basis of the complaint, unless good cause is shown for filing at a later date.
CAN A CLIENT BE PENALIZED FOR FILING A GRIEVANCE?
Providers are specifically prohibited from taking action against a client who has filed a grievance because he or she has filed a grievance.
IS THERE A CERTAIN FORM FOR FILING A GRIEVANCE?
The grievance must be filed in writing with the agency’s client rights officer (CRO). The grievance does not have to be in a specific form. It is important, however, that the grievance cover three basic points as clearly and simply as possible: (1) the specific facts related to the action that is the basis of the complaint; (2) the individual right or rights that the client claims to be violated by the staff or agency action; (3) the action that the client wants the agency to take to resolve the grievance (the “remedy” the grievant wants).
WHAT KIND OF ACTION CAN BE TAKEN TO RESOLVE A GRIEVANCE?
The client can request a number of different kind of actions to settle a grievance. The specific action depends, of course, on the nature of the grievance. Often the grievant will want two or three things done as a result of the grievance. For example, an individual whose rights were violated by a staff person who involuntarily medicated the individual in violation of the state law, may request an apology from the staff person, and a written clarification of the agency or department policy on consent to medication, and training for staff to prevent a recurrence of such violations. IT IS IMPORTANT TO SPECIFY THE ACTION THAT THE GRIEVANT WANTS TO BE TAKEN IN THE GRIEVANCE FILED WITH THE CRO. The agency may suggest alternative action to resolve the grievance.
WHAT HAPPENS TO THE GRIEVANCE?
The CRO is responsible for investigating the grievance. The CRO will check into the grievance by reviewing records and interviewing persons directly involved. A client who has an advocate should check with the advocate before discussing the matter with anyone else.
The CRO shall make an effort to mediate the grievance and to reach an agreement that is acceptable to everyone involved. If everyone agrees, the CRO can propose an “informal” resolution of a grievance which means that a formal decision is not issued. The grievant must respond to such a proposal within ten days or the grievance will be considered to be withdrawn.
If there is no informal resolution, the CRO will write a report to the agency, and provide a copy of the report to the grievant. The grievant will then have an opportunity to present additional information, and to speak with the Director in person.
ARE THERE TIME LIMITS FOR ACTING ON A GRIEVANCE?
YES. A formal decision must be issued by the agency within twenty-one days of the receipt of the grievance. However, the head of the agency may authorize an additional fifteen days if written notice is provided to the grievant of the reasonable cause for such an extension. The extension is not allowed if there is not a reasonable cause or written notice to the grievant.
WHAT IF THE CLIENT IS NOT SATISFIED WITH THE FORMAL DECISION?
The agency decision can be appealed within fifteen days of receipt by the grievant, although this time can be extended for good cause. In addition, if a formal decision is more than seven days overdue, the grievant may treat that as a denial and appeal it. An appeal must be in writing and state specifically the basis for the appeal. The appeal is filed with the DMHAS Central Office, Client Rights Division.
WHAT HAPPENS TO THE APPEAL?
DMHAS will conduct any investigation that seems necessary to review the appeal. If the matter cannot be resolved informally, a written decision will be issued within fifteen days from an informal conference, or from the date of the appeal if no conference is held.
IS THE APPEAL THE FINAL DECISION?
The written appeal decision is the final administrative action unless it results in the (1) denial, (2) involuntary reduction or (3) termination of services. If the decision results in one of these three actions by the provider, the grievant has the right to a fair hearing. The grievant must mail a written request to DMHAS for a fair hearing within thirty days from the date that the appeal decision was mailed. The request must specify the services denied, involuntarily reduced or terminated, and the date of the appeal decision.
CAN THE CLIENT CHANGE HIS OR HER MIND AFTER A GRIEVANCE IS FILED?
YES. A grievant can withdraw, or stop, the grievance at any time. It is important, however, that the client takes such action voluntarily, and that the client is not influenced in any way by agency staff to withdraw the grievance. It is a good idea for a grievant to talk with an advocate before withdrawing a grievance.
CAN THE CLIENT BE REPRESENTED BY AN ADVOCATE?
Clients have the right to advocacy services at any point in the grievance process. It is best, however, to speak to an advocate as early as possible, because the advocate can help clients understand both their rights and the process. Unlike Client Rights Officers, who work for the agency, advocates are independent, and it is their job is to represent the client in trying to get the result that he or she wants.
PROTECT YOUR RIGHTS
The State of Connecticut has established a number of specific rights to protect persons who receive services from public and private mental health treatments providers. These rights include: humane and dignified treatment; participation in developing a treatment plan; a discharge plan which provides appropriate services for the individual; voluntary informed consent to medication; and protection from unnecessary restraint and seclusion. (CLRP has produced separate flyers that explain these rights further.) The state statute allows individuals to enforce their rights by filing a law suit in Superior Court.
In order to encourage people receiving mental health services to assert and protect their rights without having to file a law suit, the Department of Mental Health and Addiction Services (DMHAS) has established a grievance procedure that applies to services provided by DMHAS or its contract agencies. These procedures provide a fairly simple and direct mechanism for clients to have their complaints addressed by providers. It is important, however, that clients understand how this process works, and how to assure that their specific concerns are addressed by the providers.
The purpose of this flyer is to give clients a basic understanding of the grievance process and how to assure that an individual’s specific concerns are recognized and addressed. It is not intended to provide every detail that an individual needs to know about the process. If a person receiving mental health services believes that his or her rights have been violated, it is advisable to contact the Connecticut Legal Rights Project. CLRP can answer your questions, assist with filing a grievance, or represent an individual in the grievance process when appropriate.
The information in this flyer is effective as of April 2001