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During your pre-operative phone call from the nurse you will be asked if you have received a written copy of this information. When you register (on the day of your procedure) you will again be asked to confirm your written and verbal receipt of the information. 

Advance Directives

Everyone has the right to make personal decisions about their health care. Doctors ask whether you will accept a treatment by discussing the risks and benefits and working with you to decide. But what if you can no longer make your own decisions? While no one is required to have an Advance Directive it does “speak” for you, to assure your religious and personal beliefs are respected. If you don’t have an advance directive and are unable to speak for yourself, then your next of kin will make health care decisions for you. 

As required by Massachusetts Law and OBRA Patient Self-Determination Act 1990, information is made available to our patients concerning their rights to execute directives. It is our policy to treat all patients equally in the provision of medical care. It is our intent to sustain life with extraordinary efforts should the need arise unless otherwise directed by a legally executed Advance Directive and as directed by the appointed Healthcare Proxy. Advance Directives will be accepted on admission of the patient. Named advocates should be readily available for contact.

This is solely informational, as required by law. Patients should consult with their attorney, physician or other advisors before making any decision. If you do not have an Advance Directive, we would be glad to provide you more detailed information and optional form(s) to assist you in writing your advanced directives. You may also obtain additional information and forms from:

Massachusetts Medical Society @ www.massmed.org 860 Winter Street, Waltham Woods Corporate Center, Waltham, MA 02451-1411   781-893-4610

Compassion & Choices @ www.compassionandchoices.org or at 800-247-7421

Grievances and Grievance Procedure

Although we strive to maintain a medically professional and compliant atmosphere, issues may arise. The Patient Grievance Procedure is a means for inquiring into an issue raised by the patient or patron, looking at the issue from all perspectives and identifying whether any action can be taken to resolve identified problems and prevent a recurrence.

In short, when a complaint has been made, the Facility representative (Administrator) records the conversation on a Grievance Report followed by a prompt investigation. Every effort is made for prompt resolution. All communication and documentation will be maintained with the Grievance Report. 

Any patient and/or support person, visitor, employee, physician, or vendor may lodge a grievance using the Center’s procedure as a formal means to voice complaints, resolve disputes concerning staff actions or procedures, or bring attention to possible violations of patient rights.

No person shall be punished or retaliated against for using the Patient Grievance Procedure. Patients are encouraged to use the grievance procedures as a formal and appropriate way to express their concerns or complaints to staff and resolve disputes, instead of relying on inappropriate, acting out behaviors.

We encourage your input. Any grievances, comments and complaints will be addressed by the Administrator, Linda Rahm. Complete details and a copy of the Center’s Grievance Policy and Procedure as well as a Grievance Form may be obtained by contacting the center. To contact a representative of the center or to request Linda Rahm, the Administrator, call 413-788-9700 or send correspondence to:

Linda Rahm  C/O Pioneer Valley Surgicenter, LLC, 3550 Main St. Ste 103, Springfield, MA 01107

You may obtain additional information and also file a complaint to:

State: DPH Secretary of Health and Human Services at www.mass.gov or 617-624-6000

• Commonwealth of Massachusetts, Board of Registration in Medicine
  200 Harvard Mill Square, Ste 330
  Wakefield, MA 01880
  781-876-8200 or TTY 781-876-8395
• www.massmedboard.org/consumer/complaint.shtm

Medicare: Contact Medicare on the web at www.medicare.gov or call Medicare at 1-800-MEDICARE (1-800-633-4227)

Patient’s Rights and Responsibilities

Respecting the unique individuality of every patient is a primary goal at Pioneer valley Surgicenter. To attain this goal, we have determined that the rights and responsibilities of every patient should be protected and preserved.

You Have The Right:

• Treatment without regard to race, sex, sexual orientation or gender, age, national origin or cultural, economic or religious background, communicable disease, disability (including HIV and AIDS, Vietnam Era Veteran status or the source of payment of care.
• Considerate and respectful care.
• The knowledge of the name of the surgeon who has primary responsibility for coordinating patient’s care and the names and professional relationships of other practitioners who will be involved with patient’s care.
• Receive information from surgeon about the illness, course of treatment and prospects for recovery in terms patient can understand. When it is medically inadvisable to give such information to a patient, the information is provided to a person designated by the patient or to a legally authorized person.
• Receive the necessary information about any proposed treatment or procedure in order to give informed consent or to refuse a course of treatment. Except in emergencies, this information shall include a description of all the procedure(s) or treatment(s) the medically significant risk(s) involved in this treatment, an alternate course of treatment or non-treatment and the risk(s) involved in each, and the name of the person who would carry out the treatment(s) or procedure(s).
• Participate actively in decision making regarding their medical care, to the extent that is permitted by law.
• Refuse treatment.
• Full consideration of privacy concerning patient’s medical care program. Case discussion, consultation, examination and treatment are confidential and shall be conducted discreetly. The patient has the right to be advised as to the reason for the presence of any individual.
• Confidential treatment of all communications and records pertaining to patient care. Written permission shall be obtained before his or her medical records are made available to anyone not concerned with patient’s care.
• Reasonable responses to any reasonable request patient makes for services.
• Reasonable continuity of care and to know in advance the time and location of appointment(s), as well as, the practitioner providing the care.
• Be advised if the surgeon proposes to engage in or perform human experimentation affecting patient’s care or treatment. The patient has the right to refuse to participate in such research projects.
• Be informed by their surgeon, or designee, or continuing health care requirements.
• Examine and receive an explanation of patient’s bill regardless of the source of payment.
• Have all patient rights explained to the person who has legal responsibility to make decisions regarding medical care on behalf of the patient.
• Express any grievances or suggestions verbally or in writing.
• Have in effect Advanced Medical Directives concerning such issues as Living Will and Durable Powers of Attorney that will be identified as appropriate under State and Federal Regulations.

Patient Responsibilities:

• To provide accurate and complete information about matters relating to patient’s health history in order to receive effective medical treatment.
• To be responsible for reporting whether patient clearly comprehends a contemplated course of action and what is expected of them.
• To cooperate with all the Pioneer Valley Surgicenter personnel and ask questions if directions and/or procedures are not clearly understood.
• To be considerate of other patients and the centers personnel and to observe the NO SMOKING POLICY and to be respectful of the property of other persons and the property of the center
• To help the physicians, nurses, and allied medical personnel in their efforts to care for the patient by following their instructions and medical order.
• To assume the financial responsibility of paying for all services rendered whether through third party payers (his/her insurance company) or being personally responsible for payment for any services that are not covered by his/her insurance policies.
• Will not take any drugs that have not been prescribed by patient attending physician and administered by Pioneer Valley Surgicenter staff.

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