Comment on AN45-Proposed Rule-Cox, Melissa Faye

As a spouse of an Air Force Loadmaster and as a Registered Nurse with experience working in mental health setting, I have a specific interest in the passage of this regulation to protect patients within the Veteran’s Healthcare System. I am aware of patient’s rights and feel that all patients, regardless of their behavior, deserve equal treatment and should not have anything withheld from them for disruptive behavior, unless the safety of the patient, the patients on the unit or the staff are at risk. In addition, any disruption that is continuous enough to cause a disruption in the programs or therapy of others must be evaluated to look for patterns of behavior, causes, medication increases or changes, or other clinical interventions that may be helpful in determining how to help the patient resolve his or her disturbances. In addition, the VA needs to update its current regulation to reflect modern medical care and ethical practices that are common in the private healthcare sector. Withholding visitation rights or any other restriction is unethical as the patient deserves rights with respect to visitations and communications, clothing, personal possessions, money, social interaction, exercise, and worship. Furthermore, any action taken against the patient should be handled clinically by a professionally licensed nurse, therapist or physician (perhaps with a multidisciplinary committee) and not handled by an untrained, typically less-educated technician. From my experience as charge nurse in an acute adolescent center for violent youth, it is imperative that these lower level employees do not make these decisions, as they often do not make the best clinical decision for the patient. However, I am aware that the safety of the patients and staff is of utmost importance as well and that the patient’s behavior must not disrupt the entire unit. This needs to be the determining factor in whether to provide any type of restrictive environment for the patient.