Introduction

This booklet provides information about the rights of patients who are at the adult psychiatric hospitals run by the State of Washington: Western State Hospital and Eastern State Hospital. A person may be required to stay at the hospital because he or she is under an order of civil commitment issued under Revised Code of Washington (RCW) 71.05. Those patients are referred to as “civil patients” in this booklet. A person may also have to stay at the hospital under RCW 10.77, the law that governs the commitment of people involved in the criminal justice system. People who are at the hospital under RCW 10.77 are referred to as “forensic patients” in this booklet. Forensic patients can include people committed to the hospital following a finding of not guilty by reason of insanity. It also includes people who are committed for competency evaluations and restoration before a criminal proceeding. Though this publication will address the rights of all patients at the state’s adult psychiatric hospitals, in some cases, the rights of patients may be different depending on whether they are civil or forensic patients because different rules may apply to these two groups. Therefore, this booklet will note when the rights of forensic patients are different from those of civil patients.
The first section of this booklet explains specific patient rights. The second section explains what a patient may do if he or she disagrees with a decision to limit or take away a right. It will also provide information about agencies or individuals a patient may contact for help. For quick reference, patients and their advocates may refer to the Table of Contents, which lists specific rights and issues, and the page number where that information can be found.


Table of Contents

Section I: Individual patient rights

1. Right to be free from abuse, neglect and harassment
2.
Right to adequate care and treatment
3.
Right to be informed of rights
4.
Right to retain basic civil rights despite admission to the hospital
5.
Right to personal privacy and sexual expression
6.
Right to religious exercise
7.
Right to voice concerns and be heard
8.
Rights relating to treatment and care
a. Right to participate in treatment planning and decision making
b. Rights relating to the hospital’s level system
c. Right to refuse antipsychotic medication, Electroconvulsant Therapy (ECT), or other treatment
d. Seclusion and restraint
e. Discharge rights
i. Discharge planning for civil patients
ii. Conditional release and related rights for forensic patients
9.
Right to contact attorneys or advocates
10.
Right to communication
a. Mail
b. Telephone access
c. Visitors
11.
Right to personal items
12.
Financial rights
a. Right to receive pay for employment
b. Right to personal funds
c. Right to receive notice regarding financial obligation for care and treatment
d. Right to control money
13.
Access to medical records

Section II: What patients can do when rights are taken away

1. Talk to the treatment team
2.
File an official written complaint with the hospital
3.
File a complaint with the hospital’s patient advocate or abuse hotline
4.
Write to the Chief Executive Officer (CEO)
5.
Contact an attorney
a. Northwest Justice Project (NJP) for WSH
b. Northwest Justice Project (NJP) for ESH
c. CLEAR
d. Department of Assigned Counsel (DAC)
6.
Contact other legal or oversight agencies
a. Disability Rights Washington (DRW)
b. U.S. Department of Health and Human Services Office for Civil Rights
c. U.S. Department of Justice (DOJ)
d. The Joint Commission
e. Washington State Department of Health


Section I: Individual patient rights

1. Right to be free from abuse, neglect and harassment
A patient has the right to receive care in a safe environment and be free from all forms of abuse, neglect, and harassment.

Hospital employees are mandatory reporters, which means they must file a report with Department of Social and Health Services (DSHS) any time there is reasonable cause to believe that a patient has been abused or neglected.

2. Right to adequate care and treatment
A patient has the right to receive adequate care based on the patient’s individual medical needs. Additionally, a patient has the right to receive a complete medical and psychosocial evaluation when first admitted to the hospital. A patient has the right to information about his or her health status and available medication and treatment.

3. Right to be informed of rights
A patient has the right to information about rights in the hospital. This is so that he or she can understand the care the hospital is providing. It is also to allow the patient to make informed choices and be a part of his or her treatment team. The hospital must tell a patient his or her rights when he or she is admitted. The hospital also has to protect and promote a patient’s rights while he or she is in the hospital, which includes a patient’s right to be free from abuse. A patient has the right to receive information about rights in a way he or she understands. This might include using an interpreter, by translation, or in accessible formats (i.e. Braille, large print).

4. Right to retain basic civil rights despite admission to the hospital
A patient keeps all civil rights unless a court has specifically limited or taken away a right. Civil rights include the right to free speech, the right to make decisions about property and sign contracts, the right to vote, the right to be free from discrimination, and the right to petition for a writ of habeas corpus (this is a document a patient can give to a court if he or she feels he or she is unlawfully detained). For example, the Washington Law Against Discrimination, RCW 49.60, states that a person cannot be treated differently based on his or her membership in a protected class (this includes race, color, national origin, sex, religious views, HIV status, sexual orientation, gender identity, or disability). A person does not lose that right when he or she is admitted to a psychiatric hospital. Similarly, if a person had the right to vote before admission to the hospital, that right cannot be taken away just because the person is in the hospital. For more information on voting rights, see DRW’s publication “Assisting Voters with Disabilities.”

5. Right to personal privacy and sexual expression
A patient has the right to personal privacy. The hospital environment and staff are to encourage the human dignity of each patient, treat all patients with respect, and help maintain a safe environment free from abuse and neglect. For example, generally, a patient’s room may be searched only when staff have a reasonable suspicion that there are contraband or restricted items in the room. A patient may watch a search of his or her room. During a search, staff must be respectful of the patient’s personal belongings and personal space.

Any time staff searches a patient’s body for dangerous items, the hospital must document a reasonable basis for the search and maintain the patient’s privacy and dignity as much as possible. In the case of both ESH and WSH, a visual scan of external body without clothing (also known as a strip search) and a body cavity search can only be conducted when reasonable suspicion exists and when the concealment of the suspected contraband constitutes an imminent threat to life or security. A strip search and a body cavity search must be ordered by a physician and approved by the CEO of the respective hospital.

At WSH, a pat-down search and a body cavity search of a patient will be conducted by staff of the same gender as the patient. At ESH, with the exception of routine searches of patient possessions (which occur upon admission, upon return from release or leave, and when patients obtain items from an outside source), at least two staff must be present for a patient search. Those staff will generally be of the same gender as the patient unless it is deemed more therapeutic and safe for the patient to have one member of the opposite gender present.

Both ESH and WSH have policies regarding sexual expression. WSH strongly discourages sexual activity in the hospital. ESH prohibits sexual activity, which ESH generally defines as contact between the genital-rectal areas of two individuals including the buttocks and the breasts of a woman. Both policies provide for individual assessments of sexual history and behavior, as well as treatment team involvement in patients’ sexual decisions. A patient should receive individualized treatment that supports his or her right to appropriate sexual expression in accordance with professional judgment while at the hospital.

6. Right to religious exercise
A patient may attend religious services on the ward. Civil patients may be able to attend services off the ward, depending on his or her level and grounds privilege status. However, a forensic patient may not leave the hospital grounds for religious services unless he or she has a conditional release or unless otherwise court ordered. A patient has the right to receive visits from a priest, rabbi, minister, or other religious person of his or her choice. A patient also has the right to treatment by spiritual means through prayer.

7. Right to voice concerns and be heard
A patient has the right to file a complaint regarding his or her care and treatment in the hospital. A patient can also have another person, called a representative, file a complaint on his or her behalf. A designated staff person must review each patient complaint. No patient should face retaliation, harassment, or the denial of care because he or she, or a family member, filed a complaint. For more on filing a complaint, see Section II below.

8. Rights relating to treatment and care

a. Right to participate in treatment planning and decision making
From the very beginning of the hospital stay, a patient has the right to discuss his or her treatment plan and participate with professionals in decision-making regarding care. Therefore, a patient should be informed of who is on his or her treatment team and what kind of care each person will be providing. In addition, the patient also should have access to professionals who can provide medically necessary medical, psychiatric, and dental care, regardless of the patient’s ability to pay. A service is “medically necessary” if it is reasonably calculated to prevent, cure or alleviate the patient’s condition and there is no other equally effective, less invasive or less costly and appropriate treatment available. If the hospital does not have qualified staff to provide medically necessary treatment, a patient may get this care from professionals in the community.

A patient may choose his or her doctor, nurse, or therapist, to the extent possible. A patient may hire a private doctor at his or her own expense, and that doctor may come into the hospital to treat the patient at any reasonable time.

A patient can always request to discuss the treatment plan with hospital staff. Though a patient may suggest different treatment options, the treatment team will only follow suggestions that the team decides are medically necessary.

This right to have input in treatment decisions is broader than just decisions regarding a patient’s mental health or medical treatment. For example, a patient has the right to receive food and meals based on the patient’s individual medical needs or consistent with the patient’s religious beliefs. A patient can explain his or her dietary or religious practice to a treatment team member so that the diet becomes a part of the treatment plan.

b. Rights relating to the hospital’s level system
Both forensic and civil patients are classified under the hospital’s level system based on his or her individual treatment needs. A patient’s level determines what privileges he or she has in the hospital. A patient can find out what privileges he or she has by asking a member of the treatment team to see the level system policies or guidelines.

A patient’s level can affect many things. For example, as a patient’s level increases, he or she may get permission to visit additional places in the hospital or go on outings into the community at large. A patient also can get increased access to personal items, such as radios and televisions. A patient can move up and down levels based on changes in his or her treatment needs. If a patient disagrees with his or her level, there are several options available. These options are outlined in Section II below.

c. Right to refuse antipsychotic medication, Electroconvulsive Therapy (ECT), or other treatment
In general, a patient has the right to refuse antipsychotic medication, although there are some exceptions. These exceptions are complicated and depend on the type of commitment, the length of commitment, and the circumstances (like an emergency). If a hospital is trying to force a patient to take antipsychotic medications, the patient should contact the attorney, if any, that represented him or her at the last commitment proceeding. A patient can also ask staff or their treatment team members at WSH and ESH for their antipsychotic medication policies and call DRW for technical assistance.

A patient has the right to refuse Electroconvulsive Therapy (ECT), and any surgery that is not emergency life-saving surgery, unless ordered by a court. A patient also has the right to refuse psychosurgery, including a lobotomy.

A patient may refuse emergency life-saving surgery if he or she has given the hospital an advance health care directive that states the patient does not want to receive such surgery. This document can indicate what type of medical care the patient would like if he or she becomes unable to communicate his or her treatment desires in the future.

A patient also can give the hospital a mental health advance directive. Mental health advance directives can say which specific mental health treatment and interventions a patient wants or does not want. They can also say which treatments a patient prefers. In the directive, a patient can choose a person, called an agent, to help with mental health decision making.

d. Seclusion and restraint
A patient has the right not to be placed in restraints or seclusion unless it is an emergency and it is necessary to ensure the immediate physical safety of the patient, staff, or others. Restraint is defined as limiting a patient’s ability to move using physical devices like straps, as well as by staff using their hands or bodies. Restraints also include the use of drugs to manage behavior or restrict movement. Seclusion is when a patient is placed in an area by him or herself and prevented from leaving.

Seclusion or restraints should only be used if other, less restrictive options have not kept the patient and others safe. Staff must record which less restrictive methods they used, and the use of restraint or seclusion in the patient’s chart. A patient should not be restrained or secluded because it is the easiest option for staff, as a form of punishment, or to force the patient to do something. A patient should be told why he or she is in restraints or seclusion and what to do to be released.

While in seclusion or restraints, a patient must be examined by a medical professional no more than an hour after the start of the seclusion or use of restraints. A patient must be monitored; most likely this will be either in person by staff or through use of video and audio equipment. If a patient continues to be an immediate danger to him or herself or others and therefore must stay in seclusion or restraints, a physician may renew the order for seclusion or restraint every four hours.

The seclusion and restraint must end at the earliest possible time or as soon as the patient no longer is an immediate danger to themselves or others. A patient who is secluded or restrained must be allowed to exercise his or her individual rights. Upon request, a patient may be provided with reasonable access to legal services, mail and letter-writing supplies, visits, and telephone calls. A patient may be denied the exercise of these rights when the registered nurse or physician determines that an item or request could result in harm to the patient or others. In general, when such rights are restricted, the staff must write down the rationale in the patient’s chart.

e. Discharge rights
i. Discharge planning for civil patients
A civil patient has the right to active discharge planning. This means that as soon as a civil patient arrives at the hospital, he or she can begin talking to the treatment team about what the patient needs to do to be discharged back to the community. A civil patient may need to ask for a discharge evaluation before a discharge plan can be created. Once this is done, a civil patient can work with hospital staff to create a discharge plan. This discharge plan will try to help the civil patient meet his or her basic and medical needs after release from the hospital.
ii. Conditional release and related rights for NGRI patients
For more information on the rights of NGRI patients, please refer to DRW’s publication, A Guide for Patients Deemed Not Guilty By Reason of Insanity (“NGRI”) at ESH and WSH.

9. Right to contact attorneys or advocates
All patients should have access to attorneys, courts and other means of addressing their legal concerns. A civil patient who has an assigned attorney has the right to the attorney’s name and contact information. Forensic patients have the right to an attorney throughout their commitment at the hospital. NGRI patients may need to request that a new attorney be assigned to their case for purposes of pursuing release if their original criminal defense attorney is no longer their attorney of record.

Patients can hire an attorney at their own expense or if they cannot afford an attorney, one may be appointed by the court. Patients may contact their attorney regarding their care and treatment at the hospital. As discussed more fully below, a patient also has the right to private and confidential mail and telephone communication with his or her attorney.

Numerous patient protection agencies are also available to assist hospital patients. A patient must be allowed to contact these agencies. Section II of this booklet provides a brief overview of these agencies, as well as their contact information.

10. Right to communication

a. Mail
In general, a patient may send and receive uncensored letters and must be given access to letter writing materials and stamps. If a patient’s treatment team or doctor limits the patient’s access to mail, the limitation must be documented in the patient’s medical chart. Restrictions on access to mail must be reevaluated at least every seven days. Patients may be required to open their mail in the presence of staff. Hospital staff may open mail only if there is a legitimate suspicion that the mail contains dangerous or contraband items.

b. Telephone access
A patient must have reasonable access to a telephone and may make and receive private telephone calls. If a patient needs to have confidential communications (for example, with an attorney or doctor), the hospital should generally provide privacy for that call. If a patient’s access to telephones is restricted or limited, staff must document the reasons for the limitation in the patient’s medical chart and must reassess the limitation every seven days.

c. Visitors
A patient may have visitors at reasonable times. The hospital must inform a patient of any clinically necessary or reasonable restriction that the hospital places on visitation rights, and the reasons behind the restrictions. Restrictions on visitors also must be documented in a patient’s record. Visitors may include a spouse, a domestic partner, another family member, or a friend. A patient may refuse to see any visitors that he or she does not wish to see.

The hospital should allow for visits to take place in a private place, particularly if the visitor is a professional with whom the patient may need to share confidential information, such as an attorney, clergy, health care provider, or law enforcement officer. A patient may see personal visitors on-ward or off-ward, depending on the privilege level and legal basis for hospitalization. A patient may ask to see the visiting procedure to review all of the rules about visits.

11. Right to personal items
Civil patients and some forensic patients have the right to keep clothing and other personal items with them as long as doing so would not be a danger to the patient or others. However, some personal items are allowed only when a patient reaches a certain level on the hospital’s level system. Each civil patient should have a personal storage space to use during his or her hospital stay. Items belonging to a patient that cannot be kept on the ward will be placed in safe storage and a list of the items will be given to the patient. The hospital will return a patient’s possessions when the patient is released from the hospital. For more information on what items are or are not allowed at the hospital, patients can ask staff or ask to see the level system guidelines.

12. Financial rights

a. Right to receive pay for employment
All patients have the right to receive payment for work that is outside of the regular chores that all patients have to do to keep their areas clean. This payment should follow federal and state laws.

b. Right to personal funds
A patient can keep a reasonable amount of money with him or her for personal use. The amount is meant to be enough for canteen expenses and small purchases. If the patient does not have a guardian, money that the patient has when he or she is admitted to the hospital may be held by the hospital superintendent and given to the patient over time for personal needs. The hospital will return any remaining money when the patient is discharged.

c. Right to receive notice regarding financial obligation for care and treatment
A patient may be asked to pay for the time he or she spends at the state hospital. However, patients have the right to notice that he or she will be asked to pay the hospital for his or her care. Such notice is called a “Notice and Finding of Financial Responsibility.” If the patient disagrees with the amount of money that he or she has been determined to be able to pay, the patient can appeal the notice by writing to:

Secretary, DSHS
Attn: Determination Officer
P.O. Box 9768 MS HJ-21
Olympia, WA 98504

It is important that a patient appeal a notice right away because the state will begin collection efforts quickly and a patient may lose the right to appeal if he or she waits too long.

d. Right to control money
The Commissioner of Social Security may make the hospital a patient’s representative payee if the Commissioner determines it would be best for the patient. That means that the hospital will manage any Social Security or SSI payments that a patient receives while they are in the hospital. However, a patient must receive notice, usually a letter, before Social Security appoints the hospital as his or her payee. If the patient disagrees with this decision, it is important that the patient appeal immediately as he or she may lose the right to do so.

Once the hospital becomes a patient’s representative payee, the hospital is required to use the patient’s funds only for the benefit of the patient. This includes paying for basic needs such as food, shelter, clothing, medical care, and personal comfort items while in the hospital. If there is money left over after providing for these needs, the hospital may pay patient debts, including outstanding hospital fees. Once the hospital releases a patient, the hospital will generally no longer serve as the representative payee.

13. Access to medical records
Patient medical records are confidential and protected under Washington State law as well as under the federal law set forth in the Health Insurance Portability and Accountability Act (HIPAA). All patients have the right to view their own medical records within a reasonable amount of time after making a request. A patient can request the hospital make corrections and add information to his or her medical records.

Generally, a civil patient’s written consent or permission is required to share confidential medical information. However, there are some exceptions to this rule. For example, confidential patient information can be shared with another hospital staff member involved in the patient’s treatment. It can also be shared with a mental health provider that is providing evaluation or treatment in the community or correctional setting. A patient’s close relatives, attorney, personal representative, guardian, or conservator may be told: (1) that the patient is in a facility; (2) that a patient is seriously physically sick; (3) the reason for the stay in the hospital, and; (4) how long he or she is expected to be there. The hospital can tell close relatives or an attorney whatever information may be necessary for them to decide whether to seek a guardian. Records may be released for limited billing purposes or by court order. If the hospital releases records to other health care providers, the person who receives the information generally must continue to keep private information confidential.

The records of forensic patients are also protected, but may be made available to a wider range of people and agencies if they demonstrate a need to access the records. Those who may access a forensic patient’s records are: the patient, his or her attorney, his or her personal physician, the supervising community corrections officer, the prosecuting attorney, the court, Disability Rights Washington, or other expert or professional persons who demonstrate a need for access to such records. Upon request, a forensic patient’s records also must be made available to the Department of Corrections or the indeterminate sentence review board if the person was on parole, probation, or community supervision at the time of detention, hospitalization, or commitment or the person is subsequently convicted for the crime for which he or she was detained, hospitalized, or committed.


Section II: What patients can do when rights are taken away

The first section of this booklet has information about individual patient rights. This section will discuss what a patient can do to regain a right that has been limited or taken away. This may include filing a complaint with the hospital about treatment, contacting an attorney, and reporting a rights violation to additional agencies and organizations.

1. Talk to the treatment team
As discussed in Section I above, a patient has the right to be a part of his or her treatment team and to discuss treatment plans and decisions with professionals. This right includes a patient’s ability to discuss the treatment team’s decision to restrict a right. In general, the treatment team should explain why the right was taken away and predict when and how the right may be restored. The team may decide that the right should not have been taken away at all.

2. File an official written complaint with the hospital
A patient can raise concerns about his or her treatment to hospital staff. Patients generally cannot be punished for making a complaint about their care. For issues related to hospital rights and medical treatment, a patient can make an official complaint through the hospital’s internal complaint process. A patient should receive information about the hospital’s complaint process when first admitted. During a hospital stay, a patient also can ask staff or treatment team members about the hospital’s complaint process.

A patient who wants to file a complaint can ask for help from another person, including hospital staff, a family member, significant other, or friend. A patient, or another person on the patient’s behalf, can turn in the completed forms. Typically, state hospitals have in the collection box on the ward. A completed form can also be mailed to one of the following addresses:

Patients at WSH:

Western State Hospital
Attn: Director of Patient Right Grievances
9601 Steilacoom Blvd SW
Lakewood, WA 98498

Patients at ESH:

Eastern State Hospital
Attn: Complaint Review Team
Quality Management Department
PO Box 800
Medical Lake, WA 99022

Once a patient has filed a complaint, the receiving staff person must respond quickly to the grievance. The receiving staff person has seven days to review the complaint and respond to the patient in writing to acknowledge receipt of the complaint. If the investigation of the complaint has been completed in these first seven days, the written response should explain who investigated the complaint, what staff did to investigate it, and what conclusions were reached. If the investigation has not been completed yet, the written notice should explain this and let the patient know what the next steps are in the process, including potential date for completion of the investigation. The patient should ultimately receive the information about who investigated, what the investigation involved, and what the conclusions are. Written response may also include the contact information for the relevant state authority where the patient may send a future complaint about the same issue. A patient can file a complaint to the oversight agencies listed on pages 21-23 of this publication.

After receiving a response, a patient may appeal the hospital’s conclusion about the complaint to the next level of review, to the appropriate state agency, the hospital CEO, and/or the Patient Advocate/Director of Consumer Affairs. The patient may also seek review or information on a complaint conclusion by contacting the DSHS Director of Patient Grievance Investigations, Kathy Davies, at (253) 756-2669.

Tips for making effective complaints:
1. Make a complaint as soon as possible after the event.
2. Put the complaint in writing and keep a copy of it.
3. Focus on one issue for each complaint.
4. Briefly talk about the who, what, when, where and why of the situation.
5. Describe what you would like to see happen.
6. Note what steps you have taken to try to bring about the change that you want.

3. File a complaint with the hospital’s patient advocate or abuse hotline
Patients with concerns about their treatment at the hospital can also speak to the patient advocate at the hospital. Typically, a patient can write a complaint to the hospital’s patient advocate by addressing a letter to them and placing it in the complaint box. A patient can also contact the advocate at the number listed below.

WSH: Consumer Advocate
9601 Steilacoom Boulevard SW
Lakewood, WA 98498

Phone: 253-761-7533

ESH: Patient Advocate
PO Box 800
Medical Lake, WA 99022

Phone: (509) 565-4520

Please note, before reaching out to the patient advocates at the numbers above, a patient might wish to ask his or her treatment team whether there is currently a patient advocate on staff at the facility. If not, the patient may ask his or her treatment team to direct the complaint to whomever is appropriate. For other questions related to this position, the patient may feel free to contact DRW.

Patients at WSH can also call the WSH Abuse/Neglect Hotline at (253) 761-7599 to report abuse or neglect in the hospital. Patients may also call Washington State Department of Social and Health Services’ End-Harm Hotline at 1-866-363-4276.

4. Write to the Chief Executive Officer (CEO)
A patient can write a letter to the Chief Executive Officer of WSH or ESH. The contact information for each CEO is:

Chief Executive Officer
Western State Hospital
9601 Steilacoom Blvd SW
Lakewood, WA 98498

Chief Executive Officer
Eastern State Hospital
PO Box 800
Medical Lake, WA 99022

For more information about filing complaints against a hospital or medical provider, see DRW’s publication “How to File a Complaint Against a Health Care Provider or Facility.”
5. Contact an attorney
Many legal services agencies provide direct legal assistance and advocacy to people in state hospitals. If a patient already has an assigned attorney, the patient may contact him or her about concerns regarding treatment at the hospital. If a patient does not have an attorney, the following agencies may still be able to provide assistance:

a. Northwest Justice Project (NJP) for WSH
NJP provides a variety of civil legal services to individual patients at WSH, including advocacy for patient rights. If a patient has concerns about the treatment or care at Western, the patient can call or write NJP at:

Northwest Justice Project (NJP) – WSH
Western State Hospital
Building 2
9601 Steilacoom Blvd SW
Lakewood, WA 98498

Phone: 1 (866) 280-4095

b. Northwest Justice Project (NJP) for ESH

NJP also provides a variety of civil legal services to individual patients at ESH, including advocacy for patient rights. If a patient at ESH has concerns about the treatment or care, he or she can call or write NJP at:

Northwest Justice Project 1702 Broadway Ave., #1818
Spokane, WA 99201
ESH Patient Advice and Referral line: (509) 381-2352

c. Department of Assigned Counsel
Civil patients at WSH with questions about their commitment can contact the Pierce County Department of Assigned Counsel (DAC), WSH Involuntary Commitment Unit. The DAC is a county public defense office, which provides advocacy to clients facing civil commitment. WSH patients can also contact the office with concerns about patient abuse and hospital conditions. The contact information for the WSH Involuntary Commitment Unit is:

Department of Assigned Council (DAC)
WSH Involuntary Commitment Unit
9601 Steilacoom Blvd. SW
Lakewood, WA 98498

Phone: (253) 756-2674

Civil patients at ESH with questions about their involuntary commitment should contact the Spokane County Public Defender.

Spokane County Public Defender
1033 W Gardner
Spokane, WA 99260

Phone: 509-477-4246

Forensic patients should have an assigned attorney or private counsel. If a forensic patient’s rights have been violated or unfairly limited, he or she should contact counsel.

6. Contact other legal or oversight agencies

The following is a list of additional organizations that are available to patients who have concerns about their treatment or placement in a hospital, or who have other legal issues that they would like to discuss.

a. Disability Rights Washington (DRW)
DRW is a private non-profit organization that protects the rights of people with disabilities statewide. DRW’s mission is to advance the dignity, equality, and self-determination of people with disabilities. DRW provides free advocacy services to people with disabilities. Calls to DRW may be anonymous and DRW must not disclose confidential or protected patient information without consent. Contact DRW for:
o Disability rights information and referrals
o Problem solving strategies for disability issues
o Community education and training
o Legal services for disability discrimination or violation of rights
o Any complaints or concerns a patient may have about his or her rights and treatment

Patients at both WSH and ESH can contact DRW at:
Disability Rights Washington (DRW)
315 5th Avenue South, Ste. 850
Seattle, WA 98104

Telephone: (206) 324-1521 or (800) 562-2702
Website: www.disabilityrightswa.org

b. U.S. Department of Health and Human Services Office for Civil Rights (OCR)
A patient may complain to OCR about (1) discrimination on the basis of race, color, national origin, disability, age, sex, or religion; or (2) violation of the HIPAA Privacy Rule, HIPAA Security Rule, or the confidentiality provisions of the Patient Safety Rule.

A patient must file a written complaint with OCR within 180 days of the alleged violation. A complaint should include identification of the staff involved and a description of the acts that a patient believes violated his or her rights. The patient may file the complaint online through the OCR website at https://www.hhs.gov/civil-rights/filing-a-complaint/complaint-process/index.html, or file the complaint in writing using the Civil Rights Discrimination Complaint Form Package. That package is available at the OCR website listed above or by contacting OCR and requesting the package. A patient may also simply file a written complaint without using the Discrimination Complaint Form Package. Written complaints can be mailed to:

Centralized Case Management Operations
U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Room 509F HHH Bldg.
Washington, D.C. 20201

Or, they may be emailed to: OCRComplaint@hhs.gov.

Both ESH and WSH patients may contact the OCR Regional Manager at:

Michael Leoz, Regional Manager
Office for Civil Rights
U.S. Department of Health and Human Services
90 7th Street, Suite 4-100
San Francisco, CA 94103
Customer Response Center: (800) 368-1019
Fax: (202) 619-3818
TDD: (800) 537-7697

Or, they may contact the Region X office in Seattle at:

Office for Civil Rights
U.S. Department of Health and Human Services
2201 Sixth Avenue – M/S: RX-11
Seattle, WA 98121-1831

Phone: (206)615-2290
FAX: (206)615-2297
TDD (206)615-2296

For more information, see DRW’s publication “How to File a Complaint Against a Health Care Provider or Facility.”

c. U.S. Department of Justice (DOJ)
Unnecessary institutionalization of people with disabilities is discrimination under the Americans with Disabilities Act (ADA). Also, under the ADA, individuals must be treated in the most integrated setting available to meet their needs. This means that community-based services must be offered to people with disabilities when:

(1) Treatment professionals determine that such services are appropriate;
(2) The affected person does not oppose community-based treatment; and
(3) Community-based services can be reasonably accommodated, taking into account the resources available and the needs of others who are receiving services.

If a patient feels that the hospital is violating his or her right to receive reasonable community-based supports, he or she can contact the DOJ and request an ADA complaint form.

U.S. Department of Justice
Civil Rights Division
Disability Rights Section, NYA
950 Pennsylvania Avenue, NW
Washington, D.C. 20530

Fax: (202) 307-1197
Phone: (800) 514-0301
TTY: (800) 514-0383

Complaints can also be filed online at: https://www.ada.gov/olmstead/olmstead_complaints.htm.

d. The Joint Commission
A person with a complaint about safety and the quality of services at ESH may file a complaint with The Joint Commission. A person can file a complaint by writing a letter summarizing the issue in three pages or less and including the name and address of the hospital. A complaint can be mailed to:

Office of Quality Monitoring
The Joint Commission
One Renaissance Boulevard
Oakbrook Terrace, Illinois 60181

For questions regarding filing a complaint with The Joint Commission, call 800-994-6610. For more information, see DRW’s publication “How to File a Complaint Against a Health Care Provider or Facility.”

Please note, in June of 2018, WSH lost its Centers for Medicare and Medicaid Services certification and is therefore no longer overseen through this federal regulatory structure. Currently, the Washington State Department of Health has a contract with DSHS to provide some services at WSH in place of The Joint Commission. Please see

e. The Washington State Department of Heath
The Washington State Department of Health investigates complaints against healthcare facilities, including WSH and ESH. Currently, the DOH also has a contract with WSH to provide additional investigative oversight after WSH lost its Centers for Medicare and Medicaid Services certification. Complaints can be mailed to:

Washington State Department of Health
Health Systems Quality Assurance
Complaint Intake
P.O. Box 47857
Olympia, WA 98504-7857

A patient can also send complaints to the Department of Health by email to hsqacomplaintintake@doh.wa.gov, or submit a complaint online at https://fortress.wa.gov/doh/opinio/s?s=ComplaintFormHPF


This information booklet is a service of Disability Rights Washington (DRW).
It provides general information as a public service only, and is not legal advice.
If you need legal advice, you should contact an attorney.
You do not have an attorney-client relationship with DRW.
If you would like more information about this topic, call (800) 562-2702 (voice)
or (800) 905-0209 (TTY).


Always advocate in a timely manner. Please be aware that there are certain time limits or deadlines to file a complaint, a lawsuit, or take legal action.

To receive this information booklet in an alternative format, such as large print or Braille, please call Disability Rights Washington (DRW) toll-free at 1-800-562-2702.

Permission to reprint this publication is granted by the author, Disability Rights Washington, provided that the publication is distributed free of charge and with attribution.

Disability Rights Washington
315 Fifth Avenue South, Suite 850
Seattle, WA 98104
T: 206-324-1521 or 800-562-2702
Fax: 206-957-0729
Email: info@dr-wa.org
Website: DisabilityRightsWA.org
Interpreters Available

DRW was formerly known as Washington Protection and Advocacy System.
DRW is a member of the National Disability Rights Network. A substantial portion of the DRW budget is federally funded.

This information is current as of March 2020