As a patient of Casa Colina, you have the right to:
Considerate and respectful care, and to be made comfortable. You have the
right to respect for your cultural, psychosocial, spiritual, and personal
values, beliefs and preferences.
Have a family member (or other representative of your choosing) and your
own physician notified promptly of your admission to the hospital.
Know the name of the licensed healthcare practitioner acting within the
scope of his or her professional licensure and who has primary responsibility
for coordinating your care as well as the names and professional relationships
of physicians and non-physicians who will see you.
Receive information about your health status, diagnosis, prognosis, course
of treatment, prospects for recovery and outcomes of care (including unanticipated
outcomes) in terms you can understand. You have the right to access your
medical records. You will receive a separate “Notice of Privacy
Practices” that explains your rights to access your records. You
have the right to effective communication and to participate in the development
and implementation of your plan of care. You have a right to participate
in ethical questions that arise in the course of your care, including
issues of conflict resolution, withholding resuscitative services and
forgoing or withdrawing lifesustaining treatment. You may request an ethics
consult by dialing extension 3018.
Make decisions regarding medical care, and receive as much information
about any proposed treatment or procedure as you may need in order to
give informed consent or to refuse a course of treatment. Except in emergencies,
this information shall include a description of the procedure or treatment,
the medically significant risks involved, alternate courses of treatment
or non-treatment and the risks involved in each, and the name of the person
who will carry out the procedure or treatment.
Request or refuse treatment, to the extent permitted by law. However, you
do not have the right to demand inappropriate or medically unnecessary
treatment or services. You have the right to leave the hospital even against
the advice of members of the medical staff, to the extent permitted by law.
Be advised if the hospital/licensed healthcare practitioner acting within
the scope of his or her professional licensure proposes to engage in or
perform human experimentation affecting your care or treatment. You have
the right to refuse to participate in such research projects.
Reasonable responses to any reasonable requests made for service.
Appropriate assessment and management of your pain, information about pain
and pain relief measures, and to participate in pain management decisions.
You may request or reject the use of any or all modalities to relieve
pain, including opiate medication, if you suffer from severe chronic intractable
pain. The doctor may refuse to prescribe the opiate medication but, if
so, must inform you that there are physicians who specialize in the treatment
of pain with methods that include the use of opiates.
Formulate advance directives. This includes designating a decision maker
if you become incapable of understanding a proposed treatment or become
unable to communicate your wishes regarding care. Hospital staff and practitioners
who provide care in the hospital shall comply with these directives. All
patients’ rights apply to the person who has legal responsibility
to make decisions regarding medical care on your behalf.
Have personal privacy respected. Case discussion, consultation, examination,
and treatment are confidential and should be conducted discreetly. You
have the right to be told the reason for the presence of any individual.
You have the right to have visitors leave prior to an examination and
when treatment issues are being discussed. Privacy curtains will be used
in semi-private rooms.
Confidential treatment of all communications and records pertaining to
your care and stay in the hospital. You will receive a separate “Notice
of Privacy Practices” that explains your privacy rights in detail
and how we may use and disclose your protected health information.
Receive care in a safe setting, free from mental, physical, sexual, or
verbal abuse and neglect, exploitation, or harassment. You have the right
to access protective and advocacy services including notifying government
agencies of neglect or abuse.
Be free from restraints and seclusion of any form used as a means of coercion,
discipline, convenience, corporal punishment, or retaliation by staff.
Receive reasonable continuity of care and to know in advance the time and
location of appointments as well as the identity of the persons providing the care.
Be informed by the physician, or a delegate of the physician, of continuing
healthcare requirements and options following discharge from the hospital.
You have the right to be involved in the development and implementation
of your discharge plan. Upon your request, a friend or family member may
be provided this information also.
Know which hospital rules and policies apply to your conduct while a patient.
Designate a support person as well as visitors of your choosing, if you
have decision-making capacity, whether or not the visitor is related by
blood, marriage, registered domestic partner status (including a same-sex
domestic partner), another family member or a friend, unless:
No visitors are allowed.
The facility reasonably determines that the presence of a particular visitor
would endanger the health or safety of a patient, a member of the health
facility staff, or other visitor to the health facility, or would significantly
disrupt the operations of the facility.
You have told the health facility staff that you no longer want a particular
person to visit.
Have your wishes considered, if you lack decision-making capacity, for
the purposes of determining who may visit. The method of that consideration
will comply with federal law and be disclosed in the hospital policy on
visitation. At a minimum, the hospital shall include any persons living
in your household and any support person pursuant to federal law.
Examine and receive an explanation of the hospital’s bill regardless
of the source of payment.
Exercise these rights without regard to and be free of discrimination on
the basis of, sex, economic status, educational background, race, color,
religion, ancestry, national origin, sexual orientation, gender identity/expression,
disability, medical condition, marital status, age, registered domestic
partner status, genetic information, citizenship, primary language, immigration
status (except as required by federal law), or the source of payment for care.
File a grievance. If you want to file a grievance with this hospital, you
may do so by writing or by calling Hospital Administration, Casa Colina
Hospital and Centers for Healthcare, 255 East Bonita Avenue, PO Box 6001,
Pomona, CA 91769-6001; 909/596-7733, ext.3000. The grievance committee
will review each grievance and provide you with a written response within
7 (seven) days of receipt. The written response will contain the name
of a person to contact at the hospital, the steps taken to investigate
the grievance, the results of the grievance process, and the date of completion
of the grievance process. Concerns regarding quality of care or premature
discharge for Medicare patients should be referred to the Quality Improvement
Organization (QIO) as follows: Livanta, 9090 Junction Drive, Suite 10,
Annapolis Junction, MD 20701 Attn: Beneficiary Complaints; 877/588-1123;
www.BFCCQIOAREA5.com. Non-Medicare patients would need to contact their
private insurance’s customer service department.
File a complaint with the California Department of Public Health Services
regardless of whether you use the hospital’s grievance process.
The California Department of Public Health Service’s phone number
and address is: California Department of Public Health Services, Health
Facilities Inspection/LACounty Acute & Ancillary Unit, 3400 Aerojet
Avenue, Suite 323, El Monte, CA 91731; 800/228- 1019 or 626/312-1135.
File a complaint with the Civil Rights Department at www.calcivilrights.ca.gov,
(800) 884-1684 or (800) 700-2320 (TTY) or 2218 Kausen Dr. #100, Elk Grove, CA 95758.
Submit written complaints related to the professional competence or professional
conduct of a physician, doctor of osteopathy, or doctor of podiatry. These
complaints should be forwarded to the only authority in the State of California
that may take disciplinary action against the provider’s license.
The applicable State Boards are as follows:
Regarding Physicians or Podiatrists: Medical Board of California, Central
Complaint Unit 2005 Evergreen Street, Suite 1200, Sacramento, CA 95815
800/633-2322 Online: www.mbc.ca.gov/consumers/complaints
Regarding a Psychologist, Psychological Assistant, or Registered Psychologist:
Board of Psychology 1625 North Market Street, Suite N-215, Sacramento,
CA 95834 866/503-3221 Online: https://www.psychology.ca.gov
Regarding Doctors of Osteopathy: Osteopathic Medical Board of California
1300 National Drive, Suite 150, Sacramento, CA 95834-1991 916/928-8390
Online: www.ombc.ca.gov/forms_pubs/a
Department of Fair Employment and Housing www.dfeh.ca.gov 800/884-1684
or 800/700-2320 (TTY) 2218 Kausen Dr., #100, Elk Grove, CA 95758
If you have concerns about patient care and safety that cannot be resolved
through the hospital, you are encouraged by the hospital to contact the
Joint Commission Office of Quality and Patient Safety by visiting https://www.jointcommission.org/resources/patientsafetytopics/report-a-patient-safety-event. You can also write to: The Joint Commission, Office of Quality and Patient Safety, One Renaissance Boulevard, Oakbrook Terrace, IL 60181.
This Patient Rights document incorporates the requirements of The Joint
Commission; Title 22, California Code of Regulations, Section 70707; Health
and Safety Code Sections 1262.6, 1288.4, and 124960; and 42 C.F.R. Section
482.13 (Medicare Conditions of Participation).
