2. WELCOME TO THE MUI RULE TRAINING Incidents Affecting Health and Safety Presented By: Kelli Nenni-Parker, Investigative Agent & Jim Crist, Investigative Agent

3. Everyone must report!  Mandated reporter (ORC 5123.61)  Responsibility to protect the health/safety of our consumers  Our reporting system is only as good as the people who report the concerns

4. Major Unusual Incidents As a mandated reporter, you are required to report all:  Alleged MUI’s  Suspected MUI’s  Actual Occurrences of MUI’s

5. New Criminal Offenses Client Endangerment (ORC 2903.341) When an MRDD caretaker creates a substantial risk to the health or safety of a client Mandated Reporters (ORC 2151.421) Everyone who interacts with a client with MRDD is a mandated reporter Sexual Conduct/Contact (ORC 5123.541) No MRDD employee shall engage in sexual contact/conduct with a client with MRDD

6. Criminal Penalty Statute  ORC 5126.058 – States that ANYONE who fails to report and is an MRDD employee shall be eligible to be included on the Abuser Registry.  ORC 5123.99 – States that failure to report is a fourth degree misdemeanor and if the incident constitutes a felony, the offense becomes a second degree misdemeanor for the person who failed to report the incident.

7. MUI RULE DEFINITIONS

8. Receiving Services v. Not Receiving Services  When an individual is WITH a provider, everything is an MUI  When an individual is NOT with a provider, the only incidents that are considered MUI’s are: - abuse- exploitation - neglect- death - misappropriation- prohibited sexual relations - failure to report

9. Physical Abuse  Physical Force  Reasonably be expected to result in harm  Examples: Hitting, slapping, pushing, dragging or throwing an object when the allegation indicates that it could reasonably result in harm

10. Verbal Abuse The purposeful use of words/gestures to threaten, coerce, intimidate or harass an individual. (what was their reaction?)

11. Sexual Abuse  Unlawful sexual contact or conduct  Now includes public indecency, importuning, and voyeurism

12. Neglect  When there is a duty to do so  Failing to provide treatment, care, goods, supervision, or services  That result in a reasonable risk of harm

13. Attempted Suicide Results in:  E.R. treatment  In-patient observation OR  Hospital admission

14. Death  All deaths of individual served

15. Failure to report (Criminal)  Person has reason to believe  Individual suffered or faces substantial risk of suffering  Any wound, injury, disability or condition to reasonably indicate abuse or neglect (including misappropriation)  Did not immediately report to law enforcement of the county board

16. Failure to report (Registry)  MR/DD employee reasonably failed to report abuse or neglect  Knew or should have known  Failure would result in a substantial risk of harm

17. Exploitation Unlawful or improper act – using an individual for personal gain, benefit, or profit

18. Misappropriation  With intent  Deprive, defraud, or otherwise obtain the real or personal property of an individual  As prohibited in the Ohio Revised Code sections 2911 and 2913

19. Missing Person - Incident has been reviewed for neglect - Not located per ISP and actions identified in the plan and search of the immediate area Or - Law enforcement called to assist in search

20. Medical Emergency Changed to include that an I.V. is now only considered a medical emergency if it was for lifesaving purposes (Heimlich, CPR, and IV for dehydration)

21. Known Injury  Known Cause  Not Abuse or Neglect  Requires: 1. Immobilization or casting 2. Five or more sutures or equivalent 3. 2 nd or 3 rd degree burns 4. Dental Injuries 5. Injury that prohibits participation in daily routine tasks for more that 2 consecutive days

22. Unknown Injury  Unknown cause  Not abuse or neglect  Requires treatment that only a physician, physician assistant, or nurse practitioner can provide

23. Law Enforcement  Individual is charged, arrested or incarcerated

24. Peer-to-Peer Acts - One individual against another - Physical abuse with intent to harm - Verbal abuse with intent to threaten - Sexual Abuse - Exploitation - Or misappropriation ($10.00 or more).

25. Prohibited Sexual Relations Any sexual conduct or contact with an individual (consensual or otherwise) with an MR/DD employee

26. Rights Code Violation  Any violation of rights listed in the Ohio Revised Code 5123.62 and it creates a reasonable risk of harm

27. Unapproved Behavior Support  Any adverse strategy or intervention  Implemented without approval by committee and guardian or without informed consent

28. Unscheduled Hospitalization  Hospital admission that is not scheduled  Unless: 1. Due to condition specified in ISP or nursing care plan 2. Specific symptoms and criteria must be listed that lead to hospitalization

29. No longer MUI’s - Relocation - Series of incidents/Patterns or trends

30. Notifications

31. The Provider ResponsibilitiesNotifications Reporting Responsibilities andTimeframes

32. Responsibilities Take all reasonable measures to ensure health & safety. Such measures include:  Immediate & on-going medical attention  Removal of an employee involved in allegations of abuse and/or neglect  Anything else that affects the health/safety of an individual The provider & CB will discuss any disagreements. If the provider & CB are not able to reach an agreement, then ODMR/DD shall make the determination.

33. Responsibilities Nothing in the rule shall prohibit a provider from contacting:  Law Enforcement  Children Services

34. Notifications/ Reporting Responsibilities Within 4 hours, notify the CB:  Sexual or Physical abuse  Misappropriation  Neglect  Exploitation  Media inquiries for an MUI that was not previously reported  Suspicious or accidental death  SUBMIT WRITTEN REPORT BY 3:00 PM NEXT WORKING DAY

35. Reporting Requirements/ Timeframes for all other MUI’s Submit a written incident report to the County Board by 3:00 p.m. the next working day following your initial knowledge – the SOONER the BETTER!

36. Reporting Responsibilities/ Timeframes Verbally notify the legal guardian or advocate selected by the individual with 24 hours of becoming aware of the MUI unless the guardian/advocate is the Primary Person Involved  Document all efforts made to complete the guardian notification

37. UNUSUAL INCIDENTS

38. Unusual Incident Reports  Write incident reports for anything that occurs that is unusual for the person receiving services (medication errors, falls, peer-to-peer (non-MUI’s), overnight relocation, injuries)  When in doubt, write it up anyway  DO NOT NEED TO DETERMINE IF THE INCIDENT IS AN MUI!!!!

39. THANK YOU FOR ATTENDING