One of the many horrors of the coronavirus pandemic was the fact that so many patients were isolated during their course of treatment of the highly contagious disease and in some instances died without loved ones at their side. Often a nurse or other caregiver were the only ones present at their passing. Out of this added grief to families, the Arkansas Legislature passed the "No Patient Left Alone Act," commonly known as Act 311.
The North Arkansas Regional Medical Center Board of Governors held its regular monthly meeting Tuesday, April 27, and were briefed on this new and important law by its general counsel John Hammons.
Many states are adopting these kinds of laws, Hammons said. The purpose for this law is to allow a patient to have one support person who is permitted to be physically present with the patient on a daily basis at reasonable times throughout his or her hospitalization, doctor's visits and any time the patient is admitted into a hospital.
Hammons said the legislature did a decent job outlining when a person has that right and what exceptions can be used for the protection of both employees and patients.
Arkansas's twist of the act is that they are making this the request of the patient. Patients can designate up to three support persons, Hammons said. At least one support person it to be present with the patient with a disability at all times in the emergency department and during the stay of a patient with a disability in the hospital, office of a healthcare professional or hospice facility if necessary to facilitate the care of the patient with a disability. Hammons said the term disability is a little bit of a gray area that he followed up on later in his presentation. For the hospital's purpose the definition is broad; "you are in the hospital for a reason."
Visitation and support for a patient with a disability is addressed under specific circumstances: Has a cognitive or mental health disability that affects the ability of a patient with a disability to make medical decisions or understand medical advice; needs assistance with activities of daily living and the staff are unable to provide or are less effective at providing the assistance; is deaf, hard of hearing, or has other communication barriers and requires the assistance of a support person to ensure effective communication with staff; is making a decision to consent to treatment or refuse treatment.
Anyone with aging parents or grandparents know that often is needed, particularly at doctors visits or to be an advocate for the patient in the hospital. The support person is there for the needs of the patient the hospital may not be able to provide on a constant basis because of staffing shortages, Hammons explained.
People entitled to a support person are those with disabilities. For hospital inpatient care the definition is so broad, he reiterated.
"Patient with a disability" means a patient who needs assistance to effectively communicate with hospital staff, make healthcare decisions, or engage in activities of daily living due to a disability such as: A physical, intellectual, behavioral or cognitive disability; deafness, being hard of hearing or other communication barriers, blindness, autism spectrum disorder or dementia. It would be hard to find an inpatient that did not qualify for disability under the Act, he said.
Qualifications to be a support person is basically anyone, Hammons continued. The act did make a bit of a distinction between a support person, a spouse and a clergyman. Distinction is without a difference, frankly, because a support person and a spouse have the same rights of visitation at the hospital, Hammons said.
The act also has some restrictions in it concerning discrimination. A healthcare professional or healthcare facility shall not discriminate against a patient with a disability by requiring the patent with a disability to: Execute an advance directive or a physician order for life-sustaining treatment as a condition of receiving treatment or visitation; or agree to a do-not-resuscitate or similar order as a condition of receiving treatment or visitation. This section of the Act does not affect any obligation of a healthcare professional or healthcare facility to: Provide patients with effective communication supports or other reasonable accommodations in accordance with federal and state law, or make exceptions to the visitor policy of a healthcare facility as a reasonable accommodation under the Americans with Disabilities Act of 1990. Hammons said while this hospital doesn't require these things to begin with there are some private institutions and nursing home this will affect more directly.
Other visitation rights under the Act were reviewed.
A child has the right to have parent, legal guardian or person standing in loco parentis physically present with the child while the child receives care in a hospital or an office of a healthcare professional..
An adult patient has the right to have a spouse, support person or legal guardian physically present with the adult patient while the adult receives care in a hospital or an officer of a healthcare professions.
An important note states a person with a right to be physically resent may leave and return to the hospital or office of a healthcare professional that is caring for the patient. A hospital may not require a person to waive the above rights to visitation.
Hospitals still have the right to restrict access for visitors. The Act allows restricting access: In cases of suspected abuse or threats of violence or to prevent disruption to the care of the child; at the request of the patient or law enforcement; due to a court order; to prevent disruption to the care of the patient; if the visitor has signs and symptoms of a transmissible infection (However, the hospital or office of a healthcare professional shall allow access through telephone, telecommunication means, or other means that ensure the protection of the patient); if the person is determined to be a danger to the patient or to be contrary to the welfare of the patient or according to visitation polices.
A proposed policy is being drafted and is being circulated, Hammons said. It would limit or restrict visitation when the presence of visitors would serve as a reason not to take a certain medical or therapeutical treatment due to the harm it would cause the patient. He explained this is a safeguard for patients if there is an acute breakout of Covid or some other infectious disease.
The policy would limit visitation if the presence of visitors would interfere with the care of or rights of any patient; visitors are engaging in disruptive, threatening or violent behavior toward any staff member, patient or other visitor or visitors are noncompliant with healthcare facility policy.
Hammons concluded that the Act treats longterm care and hospice differently than hospitals and that the clergy has some additional rights to visit patients.