TITLE:



TITLE: Abuse Reporting

PURPOSE: To comply will all laws reporting suspected abuse of children, adults, elderly, financial, domestic violence, or physical or sexual in nature.

POLICY: California law requires that medical, public and professional personnel report suspected incidents of abuse or neglect to designated local agencies. Further, the law also requires that designated hospital employees, prior to commencing employment, are educated on abuse reporting requirements and their intention to comply with provisions of the law. Mendocino Coast District Hospital will comply with such law by establishing and adhering to the following procedures.

DEFINITIONS OF ABUSE COVERED UNDER STATE LAWS:

• Emotional/Mental Abuse (Welfare and Institutions Code Section 15610.53):

o Mental or emotional injury to the person, which results in an observable and material impairment in growth or, development or psychological functioning.

o Causing or permitting the person to be in a situation in which that person sustains a mental or emotional injury resulting in an observable and material impairment in growth, development or psychological functioning.

• Physical Abuse (Welfare and Institutions Code Section 15610.63):

o Physical injury which results in substantial harm to the person, or the genuine threat of substantial harm from physical injury to the person, including an injury that is a variance with the history or explanation given and excluding an accident or reasonable discipline by a parent, guardian or managing conservator which does not expose that person to a substantial risk of harm.

o Failure to make a reasonable effort to prevent an action by another person, which results in physical injury and substantial harm to the person.

• Sexual Abuse (Penal Code Section 11160):

o Sexual contact, sexual intercourse, sexual conduct, sexual penetration with a foreign object, incest, sexual assault or sodomy inflicted on, shown to or intentionally practiced in the presence of a child or dependent adult, if the child or dependent adult is present only to arouse or gratify the sexual desires of any person.

o Failure to make a reasonable effort to prevent sexual contact, sexual intercourse, sexual conduct, sexual assault or sodomy inflicted on, shown to or intentionally practiced on in the presence of a child or dependent adult, if the child or dependent adult is present only to arouse or gratify the sexual desires of any person.

o Compelling or encouraging the person to engage in sexual conduct.

o Causing, permitting, encouraging or allowing the photographing, filming or depicting of the person if the other person knew or should have known that the resulting photograph, film or depiction is obscene or pornographic.

• Child Abuse (Penal Code Section 11165.7)

o Situation in which any person willfully causes or permits a child to suffer, or inflicts upon a child, unjustifiable physical pain or mental suffering, or having the care and custody of the child, willfully causes or permits the person or health of the child to be placed in a situation in which the child’s person or health is endangered.

o Situation where a person willfully inflicts upon a child cruel or inhuman corporal punishment or injury resulting in a traumatic condition.

• Domestic Violence (Health & Safety Code Section 1259.5):

o Physical injury which results in substantial harm to the person, or the genuine threat of substantial harm from physical injury to the person, including an injury that is at variance with the history or explanation given, excluding an accident, caused or thought to be caused by the patient’s domestic partner.

o Domestic violence includes emotional as well as physical abuse.

o Adult/Elder/Dependent Adult abuse (Welfare and Institutions Code Section 15610.07 & 15600-15659)):

▪ Adult is classified as a person ages 18 to 65 who provide their own care needs and any abuse noted in these age groups should be reported

▪ Elder Adult is considered a person over the age of 65.

▪ Dependent Adult is considered a person between the ages of 18 and 64 who has physical or mental limitations that restrict his or her ability to carry out normal activities or to protect his or her rights, including (but not limited to) persons who have physical or developmental disabilities or whose physical or mental ability have diminished because of age.

▪ Possible abuse to consider in the adult, the dependent adult, or the elderly is: physical abuse, neglect, financial abuse, abandonment, isolation, abduction, or other treatment with resulting physical harm or pain or mental suffering. Or the deprivation by a care custodian of goods or services that are necessary to avoid physical harm or mental suffering.

• Abandonment (Welfare and Institutions Code Section 15610.65):

o The leaving of the person in a situation where he/she would be exposed to substantial risk of harm without arranging for the necessary care and demonstration of an intent not to return by a parent, guardian or managing conservator.

• Neglectful Supervision (Welfare and Institutions code Section 15610.57):

o Placing in, or failing to remove, the person from a situation that a reasonable individual would realize required judgment or actions beyond the person’s level of maturity, physical condition or mental abilities and that results in bodily injury or substantial risk of immediate harm to that person.

• Medical Neglect:

o The failure to seek, obtain or to follow through with medical care for the person, with the failure resulting in an observable material impairment to the growth, development and/or functioning of that person.

• Physical Neglect:

o The failure to provide the person with food, clothing or shelter necessary to sustain the life or health of that person, but excluding failure caused primarily by financial inability, unless relief services had been offered and refused.

• The following criteria may be used to assist in the Identification of Abuse.

o When assessing for abuse, some patients may be uncomfortable with the topic and may exhibit some of the following behaviors. For some patients, these behaviors may be suggestive of abuse and disclosure of battering may follow at a later date. Abuse assessment includes, but is not limited to:

▪ Laughing or tittering (inappropriate to situation)

▪ Lack of eye contact (assess if this may be cultural, thus natural)

▪ Crying

▪ Minimizing statements

▪ Searching or engaging eye contact, expressive of fear

▪ Anxious body language: standing to leave, dropped shoulders, depressed

▪ Anger, defensiveness

▪ Comments about emotional abuse

▪ Comments about a “friend” that is abused

▪ Psychiatric, alcohol or drug use in patient or partner

o Physical Abuse-willful infliction of injury, unreasonable confinement or cruel punishment.

▪ Scratches, cuts, bruises or burns

▪ Welts, scalp injury or gag marks

▪ Sprains, punctures, broken bones or bedsores

▪ Any of above in varying stages of healing

▪ Previous suicide gestures or attempts

▪ History of prior physical or emotional abuse or neglect

▪ Depression regarding family situation, not wanting to return home, fear of safety for self or family members

▪ Vague complaints or unexplained symptoms. Complaints of tension, stress, anxiety or insomnia, fatigue, chronic headaches, dizziness or gastrointestinal complaints

▪ Confinement

▪ Substantial delay occurs between time of injury and presentation for treatment.

o Rape or other forms of sexual abuse:

▪ Trauma to the penis, vulvar and/or anal region

▪ Sexual manipulation of penis, vulvar and/or anal region with a foreign object

▪ Diagnosis of sexually transmitted disease in children and non-sexually active adolescents.

o Neglect –failure to provide for one’s self the goods or services necessary to avoid physical harm, mental anguish or mental illness or the failure of a caretaker to provide such goods or services, for example:

▪ Malnourishment, dehydration

▪ Over/under medication

▪ Lack of heat and/or running water

▪ Lack of medical care

▪ Lack of personal hygiene and/or appropriate clothing

o Exploitation – the illegal or improper act or process of using the resources of a child or an elderly or disabled person for monetary or personal benefit.

▪ Taking the Social Security/SSI check

▪ Abusing joint checking account privileges

▪ Taking property and/or other resources

o Verbal and Psychological Abuse:

▪ The caregiver of an injured child reports a change in the child (such as decreased mobility) instead of reporting an accident

▪ The extent of the injury is more severe than the reported cause would indicate

▪ The child under one (1) year old suffers a fracture of the radius, ulna, tibia/fibula or femur

• Other possible symptoms of abuse or neglect:

o Previous suicide gestures or attempts

o History of prior physical or emotional abuse or neglect

o Depression regarding family situation, not wanting to return home, fear of safety for self or family members

o Vague complaints or unexplained symptoms. Complaints of tension, stress, anxiety or insomnia, fatigue, chronic headaches, dizziness or gastrointestinal complaints.

o In persons 65 years of age and older or disabled persons:

▪ Contusions or lacerations inconsistent with the patient’s or caregivers’ explanation of the injury

▪ Contusions or lacerations are found where people are not usually injured, such as inner thighs

▪ Injuries from different causes occur at the same time (i.e., stab wound and contusion)

▪ Wounds or lesions are not properly attended

▪ The patient is dehydrated or malnourished

▪ The caregiver has provide improper levels of prescription medication

▪ The patient is wearing blood-stained undergarments

▪ The patient has suffered a spiral long bone fracture from a direct blow

▪ Symmetrical wounds or fractures are present

▪ Multiple bruised appear to be in the same evolutionary state.

• Mandated reporters (Penal Code Section 11165.7):

o Requires specified health care providers and clergy members (among others) to report suspected adult, elder, sexual or child abuse and neglect. Persons required by law to report are called “mandated reporters”

• “Reasonable suspicion” (Welfare and Institutions Code Section 15610.65):

o Objectively reasonable suspicion that a person would entertain, based upon facts that could cause a reasonable person in a like position, drawing when appropriate upon his/ or her training and experience to suspect abuse.

PROCEDURE:

All MCDH employees and volunteers as well as anyone within his or her professional capacity or in the scope of their employment having knowledge of, suspecting, or observing a victim of abuse in any patient that presents to the Hospital, shall be responsible for ensuring that the person is examined by a physician and the proper authorities are notified. The Nursing Supervisor or Case Management department should be contacted as necessary to assist with making the report and/or completing the necessary paperwork. If the abuse or suspicion of abuse is identified, the abuse must be reported to the following agencies:

Adult/Dependent Adult/Elder Abuse:

Physicians and other health care professionals who have actual knowledge of or who reasonably suspect that an Adult/Dependent Adult/Elder has been the victim of abuse should contact the Mendocino County Department of Social Services, Adult Protective Services, Fort Bragg by telephone (1-866-236-0368) within 24 hours and mail, or fax reports ("Report of Suspected Dependent Adult/Elder Abuse form SOC 341 which may be downloaded at /forensic.asp.) within 48 hours. (see attached)

Child Abuse:

If a child has been the victim of abuse or there is reasonable suspicion of abuse, health care professionals must contact law enforcement immediately by telephone (964-0200 – Fort Bragg Police or 964-6308 - Mendocino County Sheriff’s Office) and Mendocino County Child Protective Services, Fort Bragg at 1-866-236-0368 to report and follow-up with the written report by mail or fax within 36 hours.(Report form SS 8572 which may be downloaded at caag.state.ca.us/childabuse/pdf/ss_8572.pdf (see attached)

Sexual Assault or Abuse:

If an individual has been the victim of sexual assault or there is reasonable suspicion of assault, health care professionals must contact law enforcement immediately (prior to the commencement of the required medical examination) by telephone (964-0200 – Fort Bragg Police or 964-6308 - Mendocino County Sheriff’s Office) to report and follow-up with the written report by mail or fax within 36 hours.(Report form 923: Forensic Medical Report: Acute Adult/Adolescent Sexual Assault Examination, Form 925: Forensic Medical Report: Nonacute Child/Adolescent Sexual Abuse Examination; or form 930: Forensic Medical Report: Acute Child/Adolescent Sexual Abuse Examination) which may be downloaded at oes.

Suspected Abuse at a long-term care facility:

If the abuse is alleged to have occurred in a patient received from a long-term care facility (skilled nursing, intermediate care, or community care facility), the report should be made to the Mendocino County Ombudsman @ 707) 463-7950.

Suspicious Injury:

Health care providers who provide medical services to a patient for a physical condition that he/she reasonably suspects is a suspicious injury which includes any wound or other physical injury that either was: inflicted by the injured person’s own act or by another where the injury is by means of a firearm, or is suspected to be the result of assaultive or abusive conduct inflicted upon the injured person. The health practitioner is required to report to local law enforcement immediately or as soon as practically possible of discovering a suspicious injury. Form OES-920 (unless the forms listed above have been used to report) is to be completed and mailed to local law enforcement within 2 business days. (see attached)

Assault or Battery against on-duty hospital personnel:

Any act of assault or battery against any on-duty hospital personnel that results in injury or involves the use of a firearm or other dangerous weapon must be reported to the local law enforcement agency. Contact Fort Bragg Police (961-0200) Reports must be made within 72 hours of the incident. Form for reporting is found in the California Hospital Association manual (CHA form 19-1)

Where to send reports:

Fort Bragg Police

250 Cypress Street

Fort Bragg, CA 95437

961-2800 (business) 964-0200 (dispatch) 961-2806 (fax) police@

Mendocino County Sheriff’s Office

700 S. Franklin St. #110

Fort Bragg, CA 95437

964-6308

Mendocino County Adult Protective Services

825 S. Franklin St. P.O. Box 1306, Fort Bragg, CA 95437 1-866-236-0368 or 962-1102, 962-1110 (fax)

747 S. State St. P.O. Box 839, Ukiah, CA 95482 1-866-236-0368 or 463-7900, 463-7979 (fax)

Mendocino County Child Protective Services

825 S. Franklin St. P.O. Box 1306, Fort Bragg, CA 95437, 1-866-236-0368 or 962-1102, 962-1110 (fax)

P.O. Box 1060,Ukiah, CA 95482-1060, 707) 463-7990 or 866) 739-4079, 707) 463-7960 (fax)

Mendocino County Department of Social Services

P.O. Box 839, Ukiah, CA 95482, 707) 463-5000

P.O. Box 1306, Fort Bragg, CA 95437, 707) 962-1000

Other information important to know:

No person required to report a suspicion of abuse will bear criminal liability for reporting the suspected abuse. The hospital may not suspend, terminate, or discipline an employee for reporting an abuse or suspected abuse.

Failure of the healthcare provider to report is a misdemeanor punishable by a fine.

No other person will be liability for reporting suspected abuse unless the person knows the report is false.

The duty to report is individual, no supervisor or administrator may impede or prohibit reporting.

The identities of those filing reports are confidential.

In court proceedings or administrative hearings, neither the physician-patient privilege or the psychotherapist-patient privilege apply to specific abuse information required to be reported.

The hospital is required to provide education on identifying and reporting abuse and suspected abuse to all new employees upon orientation and annually.

Attachments:

• CHA Quick Reference Guide to Assault and Abuse Reporting Requirements

• Mendocino County Department of Social Services phone list and fax numbers

• Report forms:

o OES 920 Suspicious Injury Report & Instructions

o CC 8572 Suspected Child Abuse Report

o COS 341 Report of Suspected Dependent Adult/Elder Abuse & Instructions

References:

• CHA 2008 Consent Manual

• Mendocino County Resource Directory

• Joint Commission CAH 2009 Standards

New: 7/2008 Revised:

Approval Signatures:

ORIGINAL SIGNATURE ON FILE

_______________________________ ______________________

Director, Quality & Risk Management Date

ORIGINAL SIGNATURE ON FILE

________________________________ ______________________

Chief Clinical Officer Date

ORIGINAL SIGNATURE ON FILE

________________________________ ______________________

Medical Chief of Staff Date

ORIGINAL SIGNATURE ON FILE

________________________________ ______________________

Chief Executive Officer Date

ORIGINAL SIGNATURE ON FILE

________________________________ ______________________

President, Board of Directors Date

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