Denial of Rights

All facilities defined as a “facility” pursuant to NRS 433.461 must report denial of rights.  This includes: 

1. Division of Public and Behavioral Health units or subunits for the care, treatment and training of consumers;
2. Division of Child and Family Services units or subunits pursuant to NRS Chapter 433B; and
3. All hospitals (includes all departments, units, offsite emergency rooms, and other offsite locations under the hospital’s license) and Community Triage Centers.

Seclusion and the use of physical, mechanical or chemical restraints is reportable to the Commission on Behavioral Health.

• “Seclusion” means the involuntary confinement of a patient alone in a room or area from which the patient is physically prevented from leaving. Seclusion is not just confining a patient to an area, but involuntarily confining the patient alone in a room or area where the patient is physically prevented from leaving. If a patient is restricted to a room alone and staff are physically intervening to prevent the patient from leaving the room or giving the perception that threatens the patient with physical intervention if the patient attempts to leave the room, the room is considered locked, whether the door is actually locked or not. In this situation, the patient is being secluded. A patient physically restrained alone in an unlocked room does not constitute seclusion. Confinement on a locked unit or ward where the patient is with others does not constitute seclusion.
  • Note: For the purposes of reporting pursuant to NRS 433.534, the CMS definition and interpretative guidelines in CFR 482.13(e)(1)(ii) found under Tag A-0162 of the CMS State Operations Manual, Appendix A for hospitals, is being used for the definition of seclusion.   
• “Physical restraint” (NRS 433.5476) means the use of physical contact to limit a person’s movement or hold a person immobile. 
• “Mechanical restraint” (NRS 433.547) means the use of devices, including, without limitation, mittens, straps, restraint chairs, handcuffs, belly chains and four-point restraints to limit a person’s movement or hold a person immobile. 
• “Chemical restraint” (NRS 433.5456) means the administration of drugs to a person for the specific and exclusive purpose of controlling an acute or episodic behavior that places the person or others at a risk of harm when less restrictive alternative intervention techniques have failed to limit or control the behavior. The term does not include the administration of drugs prescribed by a physician, physician assistant or advanced practice registered nurse as standard treatment for the mental or physical condition of the person. 

This will depend on the purpose of medication administration. Please refer to the definition of a chemical restraint above.

No, a report only needs to be submitted when a consumer is secluded or restrained. For reporting purposes, a consumer is being defined as a patient who is held involuntarily pursuant to NRS 433A.150.

This applies to all individuals that meet the definition of a consumer (see above). Examples include:

• A report must be submitted for a disabled individual or teenager who is held involuntarily pursuant to NRS 433A.150 and is secluded or restrained.
• A report does not have to be submitted for a disabled individual or teenager who is secluded or restrained but is not being held involuntarily pursuant to NRS 433A.150.
• A report does not have to be submitted for an individual that is being held involuntarily pursuant to NRS 433A.150 but is not secluded or restrained.

There are no statutory or regulatory requirements outlining the specific information that must be reported to the Commission on Behavioral Health as it relates to reporting denial of rights pursuant to NRS 433.534. It is being requested that all hospitals and community triage centers utilize the Seclusion and Restraint Form, as described below. This allows for the consistent gathering of information.

Yes, the Seclusion and Restraint Form can be found online at this link.

The Commission:

1. Shall receive reports of and may investigate apparent violations of the rights guaranteed by this chapter;
2. May act to resolve disputes relating to apparent violations;
3. May act on behalf of consumers to obtain remedies for any apparent violations; and
4. Shall otherwise endeavor to safeguard the rights guaranteed by this chapter.

Yes, pursuant to NRS 433.534(2) such a report is confidential and must not be disclosed. A copy of the report must be sent to the Commission on Behavioral Health.

As this is confidential information, it is important to submit this information in a secured manner such as via secured, encrypted email or via United States mail.

As soon as a consumer held involuntarily pursuant to NRS 433A.150 is secluded or restrained, a report pursuant to NRS 433.534 must be submitted. As soon as possible, after the occurrence of such an event, complete the Seclusion and Restraint Form, and submit it, as instructed on the form, in a secured manner as noted in the previous question.