The health and safety of the individuals served is the first priority for Ohio's DD system, and it is something that we all play a role in – individuals, families, friends, providers, and staff. This is the second article in a series about one process that was put into place to help with that – Major Unusual Incidents (MUI). Read through the series to learn more about the MUIs process, and steps you can take to help ensure individuals' health and safety.
As we learned in the first article, MUIs: Ensuring Health and Safety, MUIs must be reported within four or 24 hours of discovery, depending on the category of the MUI. So what happens once an MUI is reported?
An MUI investigation is an administrative investigation – in this case, administrative investigation means the gathering and analysis of information related to a major unusual incident so that appropriate action can be taken to address any harm or risk of harm and prevent recurrence. An administrative investigation is different than a law enforcement investigation.
MUIs are investigated by Investigative Agents (IA). IAs are certified by DODD, and have extensive training in investigative procedures and practices. Training occurs when an IA is hired, and annually thereafter.
Most MUIs are investigated by the County Board – each County Board employs IAs. DODD conducts investigations when there is a potential for conflict for the County Board, such as when a County Board employee is involved. DODD IAs follow the same procedure as County Board IAs.
When a reportable incident occurs:
There are two important components to every investigation:
It's important to note that every MUI investigation includes these components – even in MUIs that weren't substantiated, or where the individual wasn't harmed. This is important because it helps the DD system understand where there is the potential for harm, and ways to prevent harm in the future. This is why quality reporting, or reporting every suspected, alleged, or actual occurrence, is a critical part of the system.
All MUI investigations must be completed within 30 working days. IAs can apply for an extension – extensions are granted under extenuating circumstances such as waiting for a law enforcement investigation or children's services investigation to be completed (criminal investigations take precedence over administrative investigations), waiting for a coroner's report, extra work needs to be done on a prevention plan, or multiple interviews have to be conducted and can't be completed within the established timeframe.
MUIs are an opportunity to learn and get better by identifying causes and contributing factors, and completing the prevention plan. Every MUI, whether or not it was substantiated or the individual was harmed, helps us understand what steps can be taken to ensure the well-being of individuals.
For the few most serious cases, a person can be added to the Abuser Registry, which bans them from working in the system for life. The Registry – which is publicly available – is one of the six required items on background investigations for staff; a criminal conviction is not required to add someone to the Registry. Also, DODD supports the prosecution and conviction of abusers by advocating for prosecution, and working with law enforcement and the court system through the investigative process and criminal proceedings.
If a provider shows a pattern of substantiated significant MUIs that could easily have been prevented, DODD may require a plan of correction as part of a special compliance review. If issues aren't addressed, DODD can move to suspend admissions and revoke the provider's certification.
When an MUI is discovered, providers are required to notify the individual's guardian or representative, the Service and Support Administrator, and staff and/or family living with the individual who are responsible for their care.
If an MUI is a criminal act, such as abuse, neglect, and misappropriation, local authorities also must be notified. This includes local law enforcement or the Ohio State Patrol, and children's services.
Once an investigation is complete, the County Board will share the outcome with parents/guardians. The parent or legal guardian can request a copy of the complete investigation report.
MUI reports are excluded from public records under the Ohio Revised Code. This is because MUI reports are like medical records, and include a lot of private health information such as medical and psychiatric diagnoses, medications, and behavioral history. They also include information that can be used to identify and individual, such as an individual's current and previous living arrangements and work information. Keeping MUI records private protects an individual's privacy. It also encourages people to report alleged or suspected MUIs, rather than waiting until they are certain there is wrongdoing.
There are many people who have access to MUI reports outside of Ohio's DD system, including guardians, law enforcement and prosecutors, State agencies such as the Ohio Department of Medicaid, and Disability Rights Ohio (Ohio's independent, non-profit advocacy organization). These groups regularly review specific cases as well as comprehensive data. These checks and balances ensure that the system is working effectively.
You should report MUIs to your County Board by calling your County Board's MUI hotline. If you don't feel comfortable reporting the MUI to your County Board, you can report the MUI to DODD by calling 866-313-6733 or by completing the DODD online complaint form.