Commenter:
Joanna Wise Barnes; ServiceSource, Inc.
12VAC35-105. Rules and Regulations for Licensing Providers by the DBHDS
12VAC35-105-20, Definitions of serious incidents – Level II definition #6, “Ingestion of any hazardous material” which must be reported “If any individual drinks, swallows, or absorbs a material that is hazardous to their health…it shall be reported.” We serve many individuals who engage in PICA. Calls to the Poison Control Center direct us on whether to seek emergency care, or if we can provide treatment and monitoring at our sites. We request requiring reporting only when the individual is taken to receive emergency or urgent professional medical care after ingesting any material, rather than after each occurrence of ingesting by individuals who engage in PICA. (Responses to their PICA behavior are driven not only by the Poison Control Center, but by individual protocols, behavior plans, and/or physician’s orders.)
12VAC35-105-20, Definitions of serious incidents – “Level III serious incident means serious incidents whether or not the incident occurs on the provider’s premises or within the provision of services. All providers that are made aware of a level III serious incident are required to report even if this results in duplicative reporting.” Level III, definition #1, “Any death of an individual” – When using the CHRIS system to report deaths of individuals who did not die while in our licensed program, the system requires providers to answer questions to which we lack answers. After choosing “yes” or “no” as required, we can only explain in a random textbox within CHRIS that the answers are in fact unknown. We ask that instead of using CHRIS, a provider be required to notify OL of all deaths via a documented phone call or encrypted email. Only the provider in whose care the individual died should be required to enter the death into the CHRIS system.
12VAC35-105-160, “Amend to require reporting of all level II and level III serious incidents to the department,” “A root cause analysis shall be conducted by the provider within 30 days of the discovery of Level II and Level III serious incidents,” and “The provider shall submit, or make available, reports and information that the department requires to establish compliance with these regulations and application statutes.” We appreciate the importance of tracking, analyzing, and reporting data on serious incidents state-wide. This is important to monitor services and to protect the safety of individuals served, not just for compliance with the Settlement Agreement. We request that the Comprehensive Human Rights Information System (CHRIS) be updated, or that another “web-based reporting application” replace it. The system used should be user-friendly and should require entry of all mandated information and only that information, specific to categories of serious incidents, so that only one reporting mechanism is used. Providers appreciate the availability of OHR staff to train and re-train staff on the use of CHRIS; such training is not a substitute for resolving system issues that now use considerable staff hours due to technical difficulties.
Sections 20 and 691 – These sections and probably others refer to the individual and/or the individual’s “authorized representative.” “Authorized representative” has a specific definition in the Code of Virginia. If the regulations intentionally reference that Code definition, then the term “legal guardian” should be added to these and other sections where only an authorized representative is mentioned. If on the other hand, “authorized representative” is intended as a generic term, then perhaps “substitute decision-maker” should be used instead. 12VAC35-115-145 does use the generic term “substitute decision making.”
