Loudoun County MHSADS Comments on Emergency Licensing Regulations

12VAC35-105-20. Definitions.

 “Serious Incident” –

• Determining if a hospital admission is a level II may be subjective and result in inconsistent reporting among providers. Unplanned psychiatric/medical hospital admission: what constitutes an unplanned hospital admission? For example, there are circumstances where an individual may be ECO’ed but decide to voluntarily admit herself to the hospital. At what point in the process is it “unplanned?”

• Defining “a sexual assault of an individual” as a level III incident poses a risk to the therapeutic relationship and violates an individual’s rights to privacy.  An individual who has been a victim of the sexual assault has been violated and should not be further violated by the provider disclosing the information to DBHDS if the assault did not occur during service provision “A sexual assault of an individual” should be moved to a level II incident.

• Defining “a serious injury of an individual that results in or likely will result in permanent physical or psychological impairment” as a level III incident presents multiple challenges in implementation.  First, there is ambiguity in interpreting what “results in or likely results in permanent physical or psychological impairment.”   Who determines when it causes or likely will cause “permanent” impairment?  Second, requiring this to be reported to DBHDS when not occurring during service delivery, creates an undue burden for providers.  Individuals do not have to tell providers about situations that occur outside of service provision.  How does reporting this information to DBHDS provide useful data for the provider or DBHDS?  How does this help those receiving services?  Finally, this may also violate an individual’s right to privacy.  For example, if an individual were in an accident outside of service delivery and required amputation, why would DBHDS need to know this information?

12VAC35-105-160. Reviews by the department; requests for information; required reporting.

• The required components of the root cause analysis described in E do not allow for the dignity of risk and imply that all Level II and Level III incidents have feasible mitigating solutions for identification.  Accidents happen, which cannot be prevented.  Section (iii) needs to be modified to indicate identifying “solutions to mitigate its reoccurrence” as possible.  Further, there should be clarification that an individual has the right to indicate they do not want the identified solutions implemented.  It must be clear that individuals have the right to choice and dignity of risk.