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Major Unusual Incidents

Major unusual incidents, also called MUIs, are alleged, suspected, or actual occurrences of an incident when there is reason to believe the health and welfare of a person may be adversely affected or the person is placed at a likely risk of harm.

For full definitions of each MUI type, read OAC 5123-17-02

Types of Major Unusual Incidents

Accidental or Suspicious Death

The death of a person resulting from an accident or suspicious circumstances.

For example, a person dying in a car accident.

Attempted Suicide

When a person physically attempts to take their own life and it results in emergency room treatment, inpatient observation, or hospital admission.

For example, a person states he is going to kill himself and later stabs himself with scissors. He is hospitalized for a puncture wounds. 

Death Other than Accidental or Suspicious Death

Death of a person by natural causes.


The use of a person’s resources for personal benefit, profit, or gain.

For example, a direct service provider frequently talks about how she cannot afford to buy Christmas presents for her children. The waiver participant she cares for is kind and gives the provider $500 so she can buy presents for her kids. 

Failure to Report

The failure to report abuse or neglect that resulted in a substantial risk of harm.

For example, a person reports to their direct service provider that her bus driver punched her on the back of the head. The direct service provider does not believe the person and tells no one.

Law Enforcement

Any incident that results in the person being tased, arrested, charged, or incarcerated.

For example, a person is arrested for shoplifting after taking a pack of cigarettes without paying.

Medical Emergency

An incident where emergency medical intervention is required to save a person's life.

For example, a person chokes during a meal and abdominal thrusts are performed to clear their airway.


The act of depriving, defrauding, or obtaining a person’s property.

For example, a provider steals a person's jewelry and clothing.

Missing person

An incident where a person's whereabouts are unknown, and they are believed to be at or pose a risk of harm to themselves or others.

For example, a person with limited pedestrian and verbal skills goes missing from their back yard.


When there is a duty to do so, failing to provide medical care, personal care, or other support or services that results in serious injury or places a person at a risk of serious injury.

For example, a staff member fails to secure a person's wheelchair to a bus properly and, when the bus stops, the person tips over.

Peer-to-Peer Act

Exploitation, theft, or verbal, sexual or physical act between two people served.

For example, two roommates get into a fight; one has a fractured arm that requires treatment from a doctor. 

Physical Abuse

Physical force that is reasonably expected to result in harm.

For example, a direct service provider throws a plate at a person’s head because they won’t do the dishes.

Prohibited Sexual Relations

Consensual sexual conduct or contact between a developmental disabilities employee and a waiver participant who is not their spouse.

For example, a direct service provider observes a coworker and the person she cares for kissing.The person reports that he loves his provider, they have been having sex, and he wants to marry her.

Rights Code Violation

Violation of the rights enumerated in section 5123.62 of the Ohio Revised Code that creates a likely risk of harm to health or welfare. 

For example, a direct service provider insists on taking a person to a movie even though he does not want to go. He becomes upset and bangs his head against a wall.

Sexual Abuse

Unlawful sexual contact or conduct, including public indecency and voyeurism.

For example, a person is being sexually touched and groped without their consent.

Significant Injury

An injury, that is not considered abuse or neglect, that results in concussion, broken bone, or other serious injuries.

For example, a person is hit by a car and breaks their hip.

Unanticipated Hospitalization

Any hospital stay over twenty four hours that is not pre-scheduled or planned. Does not include hospital admissions associated with specific symptoms of conditions specified in a person’s individual service plan.

For example, a person experiences severe pain in their abdomen. They are admitted for surgery to remove kidney stones.

Unapproved Behavioral Support

The use of a prohibited measure, or the use of a restrictive measure not approved by a human rights committee, that results in risk to the person's health and welfare.

For example, to prevent a person from falling into a busy street, a direct service provider grabs the person by the wrist and pulls them to safety.

Verbal Abuse

The act of forcefully criticizing, insulting, or denouncing a person. 

For example, a direct service provider berates a person’s because they won’t clean their room.