Good afternoon. Many of you have probably already received this from DODD, but I wanted to send it out again to make sure you had the opportunity to review it. Below is a clarification from the MUI unit on immediate actions to be taken in the event of an MUI. This clarification is the result of a meeting OPRA members had with DODD regarding issues with the MUI process. One significant issue of discussion was the process of putting staff (PPI/primary person of interest) on administrative leave when an MUI has been identified and is under investigation. Please note that administrative leave is not mandatory and that other remedies can be considered sufficient. If there is disagreement between the provider and the county board, the MUI unit may be contacted for assistance and a final determination.

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by System Account at 3:45 PM in Well Informed Newsletter

Through case reviews and discussion with various stakeholders, it appears that a common immediate action in Major Unusual Incidents (MUIs) is to place support staff on administrative leave and not return them to duty until the investigation is complete.

While each situation is different, we would like to provide some general guidance about rule requirements and making determinations about immediate actions to ensure health and welfare.

Immediate actions to protect "at risk" individual(s) can include many actions such as immediate retraining, removal from specific duties (medication administration, driving, money management), additional oversight, random visits by management, daily check ins with the individuals, not working alone, or administrative leave.

In some abuse, neglect and misappropriation allegations, it would be appropriate for a provider to place a staff on administrative leave until such time as the provider has reasonably determined that such removal is no longer necessary. The provider and County board shall discuss any disagreements regarding reasonable measures (including placing an employee on leave) in order to resolve them. If the provider and county board are unable to agree on reasonable measures to ensure the health and welfare of at-risk individuals, the department shall make the determination.

Once immediate actions have been agreed upon, the provider is responsible for notifying the county board or department when there are changes in protective actions (i.e. returning employee to duty, change in supervision levels, etc.).

The MUI rule requires that "when a provider has placed an employee on leave or otherwise taken protective action pending the outcome of the administrative investigation, the county board or department, as applicable, shall keep the provider apprised of the status of the administrative investigation so that the provider can resume normal operations as soon as possible consistent with the health and welfare of at-risk individuals. The provider shall notify the county board or department, as applicable, of any changes regarding the protective action.

What does the rule say?

O.A.C. 5123:2-17-02 (D) (4) states that "Immediately upon identification or notification of a major unusual incident, the provider shall take all reasonable measures to ensure the health and welfare of at-risk individuals. The provider and county board shall discuss any disagreements regarding reasonable measures in order to resolve them. If the provider and county board are unable to agree on reasonable measures to ensure the health and welfare of at-risk individuals, the department shall make the determination. Such measures shall include:

(a) Immediate and ongoing medical attention, as appropriate;

(b) Removal of an employee from direct contact with any at-risk individual when the employee is alleged to have been involved in abuse or neglect until such time as the provider has reasonably determined that such removal is no longer necessary; and

While (D) (4)(b) outlines removal of an employee in allegations of abuse and neglect, it is only until such time as the provider has reasonably determined that it is no longer necessary. There are many steps that can be taken to quickly remediate allegations of neglect while the investigation is under way. For example, if a staff is involved in a neglect allegation for not providing the appropriate level of support and there was a risk to the individual, the provider could review all the information considering any injuries, staff's actions, reporting, staff prior performance and individual's preference.

It is possible that in such a case, immediate retraining would adequately address any at risk individual(s) during the investigation and removal would not be necessary. In another scenario, a staff may be immediately removed due to an allegation of physical abuse. Removal of the staff in this situation is both for the protection of the individual(s) as well as the involved staff. If it is clear that very early into the investigation that it will not be substantiated, the staff can be returned to duty even prior to the conclusion of the investigation.

Immediate actions must focus on what is in the best interest of individual. It is the provider's responsibility to take the action with their employees. A county board or COG may recommend outcomes but it is ultimately the provider's decision to make. If the provider and CB cannot agree on acceptable immediate actions then the DODD MUI Department should be consulted to make the determination.

(D)(9) of the MUI rule requires that "when a provider has placed an employee on leave or otherwise taken protective action pending the outcome of the administrative investigation, the county board or department, as applicable, shall keep the provider apprised of the status of the administrative investigation so that the provider can resume normal operations as soon as possible consistent with the health and welfare of at-risk individuals. The provider shall notify the county board or department, as applicable, of any changes regarding the protective action.

Effective communication is the key to protecting at risk individuals. Below is a list of some of the immediate actions that may be considered. This list is no way inclusive and immediate actions should be tailored to meet individual(s) needs.

Checked for injuries
Initiated first aid
Called 911
Taken to ER
Immediate retraining
Staff was removed from specific duties (medication administration, driving, money management)
Additional oversight provided
Random visits by management (during shifts or meal times)
Completed daily check-ins with the individuals
Staff is not scheduled to working alone
Immediately retrained staff
Provided additional supports
Contacted physician and made an appointment
Ensured individual's funds were adequate for supplies and bills
Scheduled a consult with Occupational Therapist, Physical Therapist or Speech Pathologist
Completed an assessment (For example: choking or falls)
Consulted the pharmacist
Ensure individual had needed medication
Called Poison Control
Secured funds, medication or other property
Ensured that food was adequate
Made sure adaptive equipment was repaired
Separated the individuals
Placed staff on leave
Placed staff in another situation where health and safety can be ensured

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