This information pertains to regulations during the middle of the 20th century for state hospitals in the Commonwealth of Kentucky. Regulations and laws were subject to change by acts of legislation. Please remember to keep this information in a historical perspective.
The director will authorize the admission of a legally committed patient so long as the exigencies warrant admission or authorize the patient’s transfer from one institution to another when necessary.
When notified by the proper authorities or relatives that a patient has been legally committed to the state mental hospital, the superintendent shall send one or more attendants to call for the patient and accompany him to the hospital. In case of a female patient, there shall always be at least one female attendant assigned to accompany the patient to the hospital.
Correspondence with Relatives of Patients
The superintendent has the authority to make such arrangements, as he deems most feasible for the correspondence with relatives of patients concerning the welfare of the patients.
Correspondence of Patients
Every patient shall be permitted to write to some relative or friend at least once in every two weeks, in the superintendent’s discretion. If the patient is unable to write but desires to send a letter, such letter should be prepared by a proper person at suitable intervals. If the patient has a guardian, the mail matter should be disposed of according to written directions of the guardian or committee. Letters, which are obscene, profane, or otherwise objectionable, should be forward to the director, the guardian of the person, or disposed of according to the instructions of the guardian or clinical director.
Each new patient shall be received in a special section of the hospital known as the “Receiving Ward.” There shall be a special ward for men and a special ward for women intended for the sole purpose of receiving and treating new patients. The physician assigned to the receiving wards shall personally receive each new patient and they shall be assisted by the nurse in charge of the receiving ward. The “Officer of the Day” shall receive new patients committed at night or any other time when the physicians in charge of the receiving wards are not on duty. The clinical director will issue printed detailed instructions to nurses and attendants in each receiving ward for routine measure to be followed with each new admission.
Documentation of Patient Case History
The history of each new patient will be prepared in the following order; the history will be kept in a special folder with the proper identifying data. The history is recorded under the following headings:
- Family History
- Personal History
- Physical Examination
- Attitude and General Behavior
- Stream of Mental Activity
- Emotional Reactions
- Mental Trend; Content of Thought
- Sensorium, Mental Grasp and Capacity
The outline of Cheney’s “Handbook of Mental Examination” will be followed as much in detail as is practicable.
Routine Clinical Examination
- Blood (Wassermann or Kahn)
- Spinal fluid (Wassermann and Colloidal Gold test when indicated)
- Stool Examination
- Dental Examination
Other Special Examinations (when indicated)
- Bio-chemical analyses
- X-ray of chest or other portion of body
- Blood Counts
- Sputum Examination
- Ophthalmoscopic Examination
Note: A consultant should be called when necessary for certain special examinations.
- Hydrotherapy with wet pack or continuous tub will be given only on written order of the physician.
- Metrazol and insulin therapy will be given to a patient only after written consent has been obtained from the responsible relative or guardian.
- Fever therapy does not require the written consent of a relative or guardian.
New patient will be immunized against small pox and typhoid fever as soon as possible.
Mechanical Restraint and Seclusion
- Mechanical restraint or seclusion may be employed only when it is necessary for surgical or medical reasons, or to prevent a patient from injuring himself or others. The signed order of the physician is necessary for the use of mechanical restraint, and the attendants shall be instructed in the proper application of mechanical restraint. A full report of restraint or seclusion shall be kept from day to day.
- Mechanical restraint consists of any apparatus that interferes with the free movement of the patient, and which he is unable to remove. Only the camisole and restraining shoot may be used. No patient may be continuously kept in restraint more than three hours. If restraint is necessary for a longer time, the patient must be released for an interval and the restraint then reapplied. This does not apply to the Feeble-Minded Institute, where the superintendent may use other special forms of restraint when approved by the director of the Davison of Hospitals and Mental Hygiene.
- A patient is in seclusion when at any time in the day or night he is confined in a room alone with the door closed so that the patient cannot open the door from the inside. Seclusion may be used only on order of the physician. Dry packs shall not be used in the treatment of patients. Wet packs shall be used only as a therapeutic measure, on order of the physician. Records shall be kept of all restraint and seclusion.
The hours of visiting shall be arranged by the superintendent between 10 A.M. and 4 P.M., as suits the work of the institution. Attendants must not be permitted to discuss the patients’ condition with the visitors, who should be referred to the physician in charge for all information or the “Officer of the Day.” Visitors shall be treated with courtesy and shall be required to obey the rules of the institution. The superintendent can close the institution grounds against the entry of curious, careless, and noisy drivers of automobiles.
Patients’ relatives are to be notified in the event any patient becomes seriously ill. Religious requirements of the seriously ill must receive the needed attention.
Legal Protection of Patients
The superintendent shall prevent the service of legal process on patients, or the signature of patients on check, or the drawing of wills by patients, etc., except upon order of a judge of a Kentucky court of record. A patient in a state hospital may endorse checks without reference to this order, if the money is deposited in the institution’s office to be made available for the patient’s use, but not to exceed Fifty Dollars in one sum. An order against serving legal processes should be posted in the front hall of each institution.
Records of Paroled Patients
A record of parole shall be kept in each institution. Parole cards (Form No. H-16) shall be filled out in duplicates; one for the office file and one for the patient. No patient will be paroled until he has a definite place to go or where he may be expected to receive reasonable care. The county judge may make arrangements for care.
- No patient residing in a state hospital shall be employed outside the institution for private purpose.
- No patient is to be paroled if in the judgment of the staff he is homicidal, suicidal, destructive, or dangerous to himself or others. The state shall not be liable to any expense incurred by a patient who is on parole.
Reports of Accidents, Injuries, Escapes, and Suicides
The superintendent or his proxy will immediately investigate and report to the director all serious injuries, accidents, and all accidents or injuries in which an employee may be culpable, all escapes wherein the patient is not returned within twenty-four hours, and all suicidal attempts through which the patient sustains an injury. In the event of an escape, vigorous search shall be made and the correspondent relative or friend notified. One certain person employed in the institution shall be charged with carrying out all reports concerning an escaped patient. The local police need not be notified in the discretion of the superintendent.
Special Form Used to Report Injuries and Accidents:
- State whether accidental.
- Whether witnessed by employees or patients, giving names.
- State disciplinary measures taken if employee was at fault.
- Names of those notified.
Burial of Deceased Patients
Religious burial services shall be required when a deceased patient is buried in the institution’s cemetery. For additional information regarding the disposition of deceased patients, please check out this link.
Employee and Administrative Regulations
The superintendent of any Kentucky institution acts as the chief executive officer of that institution. If, for any reason, the superintendent requires leave of absence, the first assistant physician or clinical director shall perform and exercise the duties of the office of superintendent until such time the superintendent returns to duty. The superintendent supervises the management of the institution including all buildings, grounds and farms, furniture, fixtures, stock, and the direction and control of all persons therein. The superintendent also had an obligation to inspect parts of the institution and direct the care and treatment of patients. [He] will make a preliminary examination of each patient within thirty minutes post-admission to the institution. The superintendent also has the duty to visit all wards for patients at least one time a week while prescribing rules for officers and assistants to make daily inspections.
The superintendent will appoint officers and employees while setting salaries that are prescribed by law and regulation for designated positions. Based upon Kentucky’s Chandler-Wallis Act, the superintendent may remove any officer or employee. Upon the removal of any officer or employee, the superintendent is required to make a record to include the reasons for removal as a permanent record of the institution. Discharge of any employee who was been continuously employed for six months contingent upon approval by the Director of the Division of Hospitals and Mental Hygiene. The superintendent is required to record all illnesses, accidents, or deaths among employees and record these in a book.
Reports of activities on the institution will be made for each month by the fifth day of the following month to the director on forms as requested by the director. Annual reports shall be made to the director by the tenth day following the close of the fiscal year. Additionally, the superintendent shall keep record of the time of reception of patient, his name, residence, occupation, by whom brought and by what authority, on whose petition committed or received, and an abstract of all official accompanying certificates or papers. The superintendent may also utilize municipal or state laboratory services that may be received without expense to the institution other than for the cost of transportation and supplies.
The Clinical Director serves under the direction of the superintendent, as coordinator and director of all special care and treatment of the patients at the institution. His office will be in the administration center and assign all new patients to the physicians for psychiatric examination and treatment. He shall conduct staff meetings at least twice a week in order for the presentations of patients for diagnosis, treatment, parole, or discharge. Should the Clinical Director be absent, the supervisor will appoint a staff physician to act as director in his absence. Patient transfers between wards are exclusively contingent upon approval of the Clinical Director. The Clinical Director shall supervise activities of and within the clinical laboratory, X-ray, pharmacy, surgery, hydrotherapy, and occupational therapy. The Clinical Director will work closely with the Supervisor of Nurses in issuing assignments to nurses and attendants.
Supervisor of Nurses
The Supervisor of Nurses in each state hospital shall be a registered nurse with previous experience in a supervisory capacity. She shall have authority over all nurses, supervisors, and attendants. The supervisor shall keep a daily record of assignments to duty through the 24-hour period. At the Feeble-Minded Institute, a registered nurse shall have charge of the hospital for the acutely ill and be assisted by a registered nurse.
All nurses and female attendants and male attendants shall wear the prescribed uniform by the superintendent.
Note: The superintendent shall prescribe the amount of laundry to which each employee may be entitled to. Employees who live outside the institution and are required to wear a washable uniform are entitled to using the institutions laundry.
The registered pharmacist will be responsible for the care of narcotic drugs stored in a special locked container. A small number of tablets of the drugs in daily use may be placed in a locked cabinet in the pharmacy. Each physician would have a key to this cabinet and anyone who takes a drug from the cabinet should record the date, the drug and its amount, and the name of the physician, in a book kept in the cabinet.
Chief Engineer/Fire Chief
The chief engineer is responsible for testing and keeping in working condition all station equipment against fire. The chief engineer will also act as fire chief and direct all personnel assigned to special duties to fight fire. Fire drills are to be held at least once a week; patients will receive special attention during these drills so that patients will automatically respond to the call and take their places in marching to the fire exits or the doors of the fire escapes. One of these weekly fire drills shall be held at night at least once in every three months.
The dietitian will have charge of the preparation of food in all kitchens and the service of food in all dining rooms and wards. The dietitian shall plan menus for patients and personnel and write these one week in advance and submit them to the superintendent for his approval. The dietitian shall prepare monthly reports, which show the character of the food served along with the per capita cost of the daily ration.
The business manager (receiver/senior storekeeper) shall have charge of the requisitions, receiving, storage, and distribution of the supplies.
State property is divided into two categories; expendable and non-expendable property. Non-expendable property will be recounted for by the employee in charge of any division. Worn out property will be exchanged for usable property; worn out property shall be kept in a special storeroom for the inspector of hospitals to see and condemn for sale or destruction.
Rules for Employees
- All employees are subject to orders of the superintendent for immunization inoculations or health tests.
- Hours of duty are set forth by the superintendent through the heads of the different departments.
- Vacations and absence from duty are to be recorded and arranged for by the heads of the departments.
- Only employees as prescribed by law will receive food and supplies from the institution. Family members of employees are not entitled to food or supplies unless prescribed in law.
- Written consent of the superintendent is required for the transfer of an employee who requests the transfer from one institution to another.
- Before final appointment, employees are subject to physical and mental examination.
Potential employees may be rejected if they have:
- Mental deficiency to such a degree that the applicant is unable to carry on his routine tasks without constant oversight.
- Physical defects or diseases that prevent him from performing any or all of the assigned duties.
- Marked emotional unstability [sic].
- Evidence of alcoholism or drug addiction.
- Slouchy, dirty, or otherwise markedly disagreeable personal appearance or habits.
Each attendant on duty shall be required to purchase a prescribed book on the care of mentally ill patients. Attendants will be given at least 12 hours of instruction by the medical staff and the registered nurses. These classes should be held at least three times a year for new attendants.
Work Contributed By: Shawn Logan
- Commonwealth of Kentucky, Department of Welfare, Division of Hospitals and Mental Hygiene. Rules and Regulations for the Mental Hospitals and the Feeble-Minded Institute, by J. G. Wilson, Frankfort, Kentucky: DHMH, 1939.
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