Transcript Presentation - Hill Country MHDD

ABUSE, NEGLECT &
EXPLOITATION
HILL COUNTRY MHDD CENTERS
CRISIS STABLIZATION UNIT (CSU)
SUBSTANCE ABUSE PROGRAMS
ECI-1115 Waiver and Contractors
YOUR RESPONSIBILITY
To PROTECT the HEALTH
WELFARE and SAFETY of our
CONSUMERS
What is Abuse?
ABUSE: The negligent or willful infliction
of injury, unreasonable confinement,
intimidation, or cruel punishment which
caused or may have caused physical or
emotional harm or pain to a person with a
disability by that person’s caretaker, or
paid caretaker, family member, or other
individual who has an ongoing relationship
with the person.
DFPS Rules, 40 TAC §705.1001
What is a Disability?

The ADA (Americans with Disabilities Act) defines a
person with a disability as: A person who has a
physical or mental impairment that substantially limits
one or more major life activities.

(major life activities include, but are not limited to, caring for oneself, performing manual tasks,
seeing, hearing, walking, standing, lifting, bending, speaking, breathing, learning, concentrating,
thinking, and working.)
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The ADA also makes it unlawful to discriminate
against a person with a disability.
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"disability is a natural part of the human experience and in no way
diminishes the right of an individual to participate in, or contribute
to society." - Unknown
YOUR DUTY
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It is your duty to perform your job in a way
that will never abuse, neglect or exploit
consumers.
We will discuss ways to
RECOGNIZE what abuse, neglect or
exploitation is.
RESPOND to the consumer/allegation, and
protect every patient/consumer.
REPORT possible abuse, neglect &
exploitation to the proper reporting agency.
TYPES OF ABUSE
 Sexual
Abuse-(Sexual Exploitation)
 Physical Abuse
 Exploitation (Money, Resources,
Property)
 Verbal orEmotional Abuse
 Neglect
SEXUAL ABUSE
“Sexual abuse of an elderly or disabled person,
including any voluntary, involuntary or
consensual or nonconsensual sexual conduct that
would constitute an offense under Section 21.08,
Penal Code (indecent exposure) or Chapter 22,
Penal Code (assaultive offenses), committed by
the person's caretaker, paid caretaker family
member, or other individual who has an ongoing
relationship with the person”
DFPS Rules, 40 TAC §705.1005
Sexual Abuse
Examples
ANY sexual activity or conduct between
staff and consumer such as:
 Kissing.
 Staff having an intimate relationship with
a patient or consumer.
 Inappropriate touching, requesting,
suggesting or encouraging any sexual
activity.
 Sexual Assault.
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PHYSICAL ABUSE
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When an alleged perpetrator is a caretaker, paid
caretaker, family member, or other individual
who has an ongoing relationship with the alleged
victim, physical abuse is defined as any knowing,
reckless, or intentional act or failure to act,
including unreasonable confinement, corporal
punishment, inappropriate or excessive force, or
intimidation, which caused or may have caused,
physical injury, death, or emotional harm.
DFPS Rules, 40 TAC §705.1003
SIGNS & SYMPTOMS
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Unusual patterns of injuries such as bruises,
bites or burns.
Frequent unexplained injuries.
Extreme fear of a specific employee.
Serious injury.
Verbal allegations.
Hitting
Pushing
Spitting
VERBAL-EMOTIONAL
ABUSE
The use of verbal or other communication,
including gestures to;
 Curse
 Vilify or Degrade (Slanderous or abusive
language)
 Humiliation
 Threaten a person with emotional or
physical harm
DFPS Rules, 40 TAC §705.1007
Verbal-Emotional Abuse
Examples
Speaking to a patient/consumer in a loud,
angry sounding voice
 Cursing at or in the presence of a
consumer
 Using gestures toward patient/consumer
 Name calling
 Using threatening words and body
language

EXPLOITATION

Illegal or improper act or process of a
caretaker, paid caretaker, family member, or
other individual who has an ongoing
relationship with an elderly or disabled person
that involves using, or attempting to use, the
resources of the elderly or disabled person,
including the person's social security number
or other identifying information, for monetary
or personal benefit, profit, or gain.
DFPS Rules, 40 TAC §705.1011
Exploitation
Examples
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Accepting gifts (monetary or purchased) of any
value
You may accept food items if it is shared with
co-workers AND consumers
Borrowing personal items which belong to
consumers
Consumers do not work for you
Buying or giving gifts to consumers
NEGLECT
When an alleged perpetrator is a caretaker
or paid-caretaker, neglect is defined as:
• the failure to provide for protection, food,
shelter, or care necessary to avoid
emotional harm or physical injury; or
• a negligent act or omission that caused or
may have caused emotional harm, physical
injury, or death.
DFPS Rules, 40 TAC §705.1009
NEGLECT
Examples

Failure to assist consumer when requested
(reasonable request)
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Failure to provide adequate nutrition
clothing or shelter (IDD-HCS)
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Failure to provide prescribed medications
in a timely manner
NEGLECT
Continued
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Failure to establish and carry out an
appropriate individual treatment plan of
services
Failure to assist patient/consumer with the
activities of daily living if necessary
Leaving a person unattended when unless PDP
states otherwise (IDD)
Allowing Consumers to argue/fight without
intervention
Talking or texting on cell phone while driving
NEGLECT
Continued
 While
at work, HCMHDDC staff will
NOT, watch or rent movies or
programs that are rated PG or R if the
program contains sexually explicit or
violent content.
Off-hour patient interaction
(MH)
Under no circumstances will staff fraternize
with current or former patients on a personal
level.
This may be grounds for disciplinary action, up
to and including possible termination.
Entering into any type of personal relationship
with a patient is considered a conflict of
interest, no matter how minor it may be.
PATIENT INTERACTION
Examples

You are at a party where a person who is a
known consumer asks you for a ride to their
home which is only a few blocks from the
location of the party. You recognize this
person as having been a consumer with Hill
Country MHDD Centers. This person has
obviously been drinking and would not be safe
walking the distance. What would you do?
REPORTING
ALLEGATIONS
REPORTING
It is your Legal, Ethical and Moral responsibility to
report any allegation of Abuse, Neglect or Exploitation
within one (1) hour when you See it, Hear it, or Suspect
it.

Failure to report an incident is considered a criminal offense: Class
A misdemeanor

Texas 2013 HB 1205- Makes the penalty for a professional who
knowingly fails to make a report a Class A misdemeanor, except
that the offense is A State Jail Felony if it is shown during the trial
of the offense that the actor intended to conceal the abuse, neglect
or exploitation.
Classification of Misdemeanors In Texas
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Misdemeanors are classified according to the relative seriousness of the
offense into three categories:
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1. Class A Misdemeanor: MA . Punished by: Fine not to exceed $4,000 or
confinement in jail for a term not to exceed one year; or both such fine and
imprisonment.
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2. Class B Misdemeanor: MB-Punished by: A fine not to exceed $2,000 or
confinement in jail for a term not to exceed 180 days; or both such fine
and imprisonment.
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3. Class C Misdemeanor: MC- Punished by: A fine not to exceed $500.
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Examples of class C include certain types of assault, aiding suicide, leaving a child in a
vehicle, criminal mischief, reckless damage or destruction and criminal trespass.
Classification of Felony's
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1. First Degree Felony: F1-Punished by: Confinement in the institutional division for
life or for any term not more than 99 years or less than 5 years and a fine not to exceed
$10,000.
2. Second Degree Felony: F2-Punished by: Confinement in the institutional division for
life or for any term not more than 20 years or less than 2 years and a fine not to exceed
$10,000.
3. Third Degree Felony: F3-Punished by: Confinement in the institutional division for
life or for any term not more that 10 years or less than 2 years and a fine not to exceed
$10,000; and
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State Jail Felony Punishment: FS Punished By: An individual adjudged guilty of a state
jail felony shall be punished by confinement in a state jail for any term of not more than
2 years or less than 180 days; and a fine not to exceed $10,000.
Texas Dept. Family &
Protective Service (TDFPS)
TDFPS
1-800-647-7418
 Facility Investigations
 Staff are on duty
 24 hours a day – 7 days a week

Texas Department of State
Health Services (DSHS)

Hill Country MHDD Staff who are
stationed at the Crisis Stabilization Unit will
call the number posted at the CSU for
DSHS- Listen carefully to the instructions,
once complete call the Rights Protection
Officer.
 DSHS-
888.973.0022 x 2606
 RPO- 830.258.5441 or x 2066
MAKING THE CALL

You must report all known or suspected
allegations of abuse, neglect &
exploitation within one hour from the
time you witness or learn of the incident.

You may be put on hold and it could last
several minutes, don’t hang up.
INFORMATION TO BE
GIVEN
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Give complete information about the consumer
– Name, Address, Phone, Age, any other
important information about the consumer, if
asked.
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You may give medical information if it is
necessary for the report.
REPORTS ARE
CONFIDENTIAL
Once you have made the report, this
information is required to remain
confidential.
 You are not at liberty to discuss with
anyone.
 Do not report any allegations to your
supervisor or anyone else.

NEED ADVICE BEFORE
CALLING?
You may call
Wm. A. Olden, R.P.O
830.258.5441 or x 2606
1.888.393.3629 toll free
THE INVESTIGATION
In most cases, a DFPS investigator will
come to the clinic/center to ask questions
and review the records. You are
expected to cooperate fully.
There are some cases they do not
investigate. I will investigate those cases
and determine the outcome.
RETALIATION
What is
RETALIATION?
RETALIATION
Any action intended to inflict emotional
or physical harm or inconvenience to an
employee who has reported abuse,
neglect, exploitation.
This could include harassment,
disciplinary measures, discrimination,
reprimand, threats, censure or criticism

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DFPS Rules, 40 TAC §705.1003
RETALIATION IS
PROHIBITED
If you feel that someone has or is retaliating
against you for doing the right thing, you
should immediately notify:
Sheree Hess
Human Resource Director
830-792-3300 XT 2044
You must report abuse
allegations when
When you see it
When you hear about it
When you suspect it

YOU REPORT ABUSE TO

Abuse, Neglect & Exploitation is
reported to:
DFPS
Texas Dept of Family & Protective Services
1-800-647-7418
DFPS number can be found on the Abuse,
Neglect and Exploitation flyers in every
office & building HCMHDDC occupies.
RIGHTS
HUMAN RIGHTS
life, liberty and pursuit of happiness
 freedom from torture, or cruel, inhuman or
degrading treatment or punishment
 equality before the law not being subjected
to arbitrary arrest, detention or exile
 freedom of movement and residence
 freedom of thought, conscience and religion
 peaceful assembly and association
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CIVIL RIGHTS
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1st.
Freedom of speech, press, religion, peaceable assembly, and to
petition the government for redress
2nd. Right for the people to keep and bear arms, as well as to maintain
a militia, this right shall not be infringed.
3rd. Protection from quartering of troops
4th. Protection from unreasonable search and seizure
5th. Due process, double jeopardy, self-incrimination, private property
6th. Trial by jury and other rights of the accused
7th. Civil trial by jury
8th. Prohibition of excessive bail, as well as cruel and unusual
punishment
9th. Protection of rights not specifically enumerated in the Bill of Rights
10th. Powers of states and people
Consumer Rights
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Right to be treated with respect and dignity
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Right to receive age and culturally appropriate services
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Right to understand available treatment options and alternatives
(informed consent)
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Right to receive care that does not discriminate on the basis of age,
race, or type of illness
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Right to privacy and personal possessions
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Freedom of movement, from fear and to make treatment choices
SPECIAL RIGHTS
Federal & State laws were passed giving individuals with mental
illness & mental retardation additional special rights
Right to Normalization
Least Restrictive Environment
Participate in and receive individualized services
Informed Consent
CONFIDENTIALITY
People with mental illness may have additional rights that are protected under the
following laws:
Americans with Disabilities Act.
Fair Housing Amendments Act.
Civil Rights of Institutionalized Persons Act.
Individuals with Disabilities Education Act.
RIGHTS VIOLATIONS
If an individual believes their rights have
been violated, it is their right and your
responsibility to report the violation within
one (1) hour or assist them in making a call
to:
Wm. A. Olden, R.P.O.
830.258.5441
1-888-393-3609 (Toll Free)
Reporting Rights Violations
Rights violations can also be reported to
the state rights protection service at:
Consumer Rights and Services Office
MH – 1-800-252-8154
MR – 1-800-458-9858
COMPLAINTS
COMPLAINTS
If a consumer, their guardian, legally
authorized representative, family or
friend wishes to file a complaint about
our services or employees, they may do so
by calling:
Wm. A. Olden, R.P.O.
830.258.5441 or x 2066
1-888-393-3609 (Toll Free)
OTHER COMPLAINT LINES
Texas Dept. Health & Human Services
MH – 1-800-252-8154
MR – 1-800-458-9858
CONFIDENTIALITY
WE MUST MAINTAIN
CONFIDENTIALITY
We never share personally identifying
information about those we serve with
anyone who does not have a need for the
information
Never verify an individual is receiving
services at HCMHDDC without a written
consent to do so.
CONSENT TO RELEASE
INFORMATION
We do not share personal identifying
information about a patient/consumer
with anyone not directly working with
that individual unless that individual or
their LAR gives WRITTEN consent.
Do not discuss your patient/consumer
with relatives, friends, family or former
employees.
SHOULD I GIVE THE
INFORMATION?
If you are not sure whether someone should
have access to confidential information,
always assume they DO NOT. Refer
them to your supervisor or call:
Wm. A. Olden, R.P.O. x 2066
Or
Sheree Hess Dir. HR. x2044
EXCEPTIONS
There are some exceptions to the rule:
Patient/Consumer can talk to anyone they wish
Law Enforcement (Crisis Situation)
Medical Emergency Personnel (Crisis Situation)
Auditors and TDFPS Investigators.
CASE SENARIO
Two staff standing in doorway of office talking
about consumer.
You are in your office two doors away and clearly
hear them discussing how the new behavior
program is not going to work. You heard the
consumers name but do not know her.
You also overheard one of them say she got so
tired of her screaming last night that she blocked
her door when she went to her room so she
couldn’t get out for a while.
What are the problems in this
scenario?
The
2 staff should have been in the office with the
door closed.
Locking
the consumer in her room might be
considered Physical Abuse if she injured herself
trying to get out, had a seizure, etc.
Or
this action might be considered Seclusion.
CASE SCENARIO #2
A 32 year old male who is a consumer of HCMHDDC,
diagnosed with schizophrenia, comes to the clinic. He
appears as un-kempt, agitated gentleman, who is talking
to himself, he is making threating and paranoid
statements. Reported to have been off his meds more
than a month and has been actively hallucinating.
States he is going to kill his wife because he believes she is
worshiping demons and is possessed by Satan. States his
plan is to wait until she is sleeping, then he will set her
“free”. Consumer suddenly gets up and leaves the clinic.
What action if any should be taken to protect the patient
and the wife?
CASE SCENARIO
The
staff should notify the authorities- 911
Authorities
may notify wife to let her know
she may be in danger
EXCEPTIONS
When there is good reason to believe a
specific individual(s) is placed in serious
danger depending on the information at
hand.
Example: When a patient shares a specific
plan (homicide) to harm a specific
individual (wife).
Tarasoff in Texas
Under ethical standards tracing back to the Roman Hippocratic Oath, doctors and mental health
professionals usually must maintain the confidentiality of information disclosed to them by patients in the
course of the doctor-patient relationship. With some exceptions codified in state and federal law, health
professionals can be legally liable for breaching confidentiality. One exception springs from an effort to
protect potential victims from a patient’s violent behavior. California courts imposed a legal duty on
psychotherapists to warn third parties of patients’ threats to their safety in 1976 in Tarasoff v. The Regents of
the University of California. This case triggered passage of “duty to warn” or “duty to protect” laws in almost
every state as summarized in the map and, in more detail, in the chart below.
Tarasoff in Texas
Texas
Tex. [Health
and Safety]
Code Ann.
§611.004
Yes Permissive
Mental Health
Professionals
Sept. 1,
2005
A mental health
professional may
disclose information only
to medical or law
enforcement personnel if
the professional
determines that there is
a probability of imminent
physical injury by the
patient to the patient or
others or there is a
probability of immediate
mental or emotional
injury to the patient.
FORMER EMPLOYEE
STOPS BY TO VISIT
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A former employee stops by to visit the
staff and consumers.
Former employees have no business in our
offices or consumer areas. They are to be
asked to leave the building.
They are no longer bound by HCMHDDC
Policies & Procedures
INFORMATION TO FAMILY
MEMBERS

Never assume a family member automatically has a
right to a patient’s personal information.
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Check for a signed consent before giving out the
information.
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If there is not one, ask the patient if they would like
to sign one. If the family member becomes angry,
refer them to your supervisor or:
Wm. A. Olden, R.P.O.
830.258.5441 or x2066
MAINTAINING
CONFIDENTIALITY
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Keep all records secure in locked files
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Never leave documents with patient information
exposed on your desk, car, etc.
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If you use a computer, make sure screen is facing away
from the door where others can see it
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Shred all unwanted files
BREACH OF
CONFIDENTIALITY

If you witness or hear about a breach of confidentiality
by a co-worker, you should:
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Talk with your co-worker about revealing patient
information.
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Report the incident to the R.P.O.
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Confidentiality violations threaten the integrity of the
patient-staff relationship as well as HCMHDDC. You
should always take this seriously.
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You can as an indiviual be sued and fined for violations