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PANEL DISCUSSION : Special Populations

PANEL DISCUSSION : Special Populations. SC ATTORNEY GENERAL’S OFFICE Medicaid Fraud Control Unit. Charles W. Gambrell, Jr. Assistant DeputyAttorney General Director, Medicaid Fraud Control Unit. Omnibus Adult Protection Act. Omnibus Adult Protection Act = OAPA

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PANEL DISCUSSION : Special Populations

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  1. PANEL DISCUSSION:Special Populations

  2. SC ATTORNEY GENERAL’S OFFICEMedicaid Fraud Control Unit Charles W. Gambrell, Jr. Assistant DeputyAttorney General Director, Medicaid Fraud Control Unit

  3. Omnibus Adult Protection Act • Omnibus Adult Protection Act = OAPA • SC Code 1976 §43-35-5 et.seq. • §43-35-10 = Definitions

  4. §43-35-10(1) - Abuse • Abuse = physical abuse or psychological abuse

  5. §43-35-10(2) – Caregiver • Provides care to a vulnerable adult • With or without compensation • Temporary or permanent • Full or part-time • Can be a • relative • household member • day care personnel • adult foster home sponsor • personnel of a public • private institution or facility

  6. §43-35-10(3)(a) – Exploitation • Causing or requiring a vulnerable adult to engage in activity or labor which is improper, unlawful, or against the vulnerable adult’s reasonable and rational wishes

  7. §43-35-10(3)(b) – Exploitation • Improper, unlawful, or unauthorized use of the funds, assets, property, power of attorney, guardianship, or conservatorship of a vulnerable adult by a person for the profit or advantage of that person or another person

  8. §43-35-10(3)(c) – Exploitation • Causing a vulnerable adult to purchase goods or services for the profit or advantage of the seller or another person through: (i) undue influence, (ii) harassment, (iii) duress, (iv) force, (v) coercion, or (vi) swindling by overreaching, cheating, or defrauding the vulnerable adult through cunning arts or devices that delude the vulnerable adult and cause him to lose money or other property.

  9. §43-35-10(3) – Exploitation • Does NOT include requiring a vulnerable adult to participate in an activity or labor which is a part of a written plan of care or which is prescribed or authorized by a licensed physician attending the patient

  10. §43-35-10(4) – Facility • A nursing care facility, community residential care facility, a psychiatric hospital, or • any residential program operated or contracted for operation by • Department of Mental Health or • Department of Disabilities and Special Needs

  11. §43-35-10(5) – Investigative entity • Long Term Care Ombudsman Program • Adult Protective Services Program in the Department of Social Services • See §43-35-15 and §43-35-20 for more detail on investigative entities

  12. §43-35-10(6) - Neglect • Failure or omission of caregiver to provide the care, goods, or services necessary to maintain the health or safety of a vulnerable adult • food, clothing, medicine, shelter, supervision, and medical services • May be repeated conduct or a single incident • Produced or can be proven to result in serious physical or psychological harm or substantial risk of death • Includes the inability of a vulnerable adult, in the absence of a caretaker, to provide for his or her own health or safety which produces or could reasonably be expected to produce serious physical or psychological harm or substantial risk of death

  13. §43-35-10(6) - Neglect • Noncompliance with regulatory standards alone does not constitute neglect.

  14. §43-35-10(7)- Occupational licensing board • A health professional licensing board which is a state agency that licenses and regulates health care providers • Examples: • Board of Long Term Health Care Administrators • State Board of Nursing for SC • State Board of Medical Examiners • State Board of Social Work Examiners • State Board of Dentistry

  15. §43-35-10(8) – Physical Abuse • Intentionally inflicting or allowing to be inflicted physical injury on a vulnerable adult by an act or failure to act • Includes, but is not limited to, slapping, hitting, kicking, biting, choking, pinching, burning, actual or attempted sexual battery as defined in §16-3-651, use of medication outside the standards of reasonable medical practice for the purpose of controlling behavior, and unreasonable confinement • Use of a restrictive or physically intrusive procedure to control behavior for the purpose of punishment

  16. §43-35-10(8) – Physical Abuse • Does NOT include: • a therapeutic procedure prescribed by a licensed physician or other qualified professional or that is part of a written plan of care by a licensed physician or other qualified professional • altercations or acts of assault between vulnerable adults.

  17. §43-35-10(9) – Protective services • Services with the objective to protect a vulnerable adult from harm caused by the vulnerable adult or another person • Including: • evaluating the need for protective services • securing and coordinating existing services • arranging for living quarters • obtaining financial benefits to which a vulnerable adult is entitled • securing medical services, supplies, and legal services

  18. §43-35-10(10) – Psychological abuse • Deliberately subjecting a vulnerable adult to threats or harassment or other forms of intimidating behavior causing fear, humiliation, degradation, agitation, confusion, or other forms of serious emotional distress.

  19. §43-35-10(11) – Vulnerable Adult • 18 years or older • Has a physical or mental condition • which substantially impairs the person from adequately providing for his or her own care or protection • Due to infirmities of aging, including: • organic brain damage • advanced age, and • physical, mental, or emotional dysfunction. • A resident of a facility is a vulnerable adult.

  20. §43-35-25(A) – Mandated Reporters • physician • nurse • dentist • optometrist • medical examiner • coroner • other medical • mental health or allied health professional • Christian Science practitioner • Religious healer • school teacher • counselor • psychologist • mental health • mental retardation specialist social worker • public assistance worker • caregiver • staff or volunteer of an adult day care center • staff or volunteer of a facility • law enforcement officer

  21. §43-35-25 – Mandated Reporters • (B) = Any other person with reason to believe that a vulnerable adult has been or is likely to be abused, neglected, or exploited • (C) = Shall report the incident personally

  22. §43-35-25(D) – Mandated Reporters • Incident must be reported orally by telephone or in writing within 24 hours to • SLED VAIU for incidents in facilities operated by or contracted for operation by DMH or DDSN • Long Term Care Ombudsman for incidents in all other facilities • APS for incidents in all other settings

  23. §43-35-30 – Mandated Reporters • May take photographs of trauma to vulnerable adult • Investigative entity/law enforcement may have x-rays taken or a medical examination of the vulnerable adult performed without consent

  24. MFCU CONTACT INFO • MFCU Hotline: 1-800-NO-CHEAT 1-800-662-4328 • AG’s Office – MFCU: 803-734-3660 • SC Attorney General’s Office Medicaid Fraud Control Unit PO Box 11549 Columbia, SC 29211-1549

  25. The Vulnerable Adults Investigations Unit was established May 23, 2006. The Unit began receiving cases January 30, 2007. • The Unit receives and coordinates the referral of all reports of alleged abuse, neglect, or exploitation of vulnerable adults in private facilities to include those facilities operated or contracted for operation by the: • Department of Mental Health (DMH) • Department of Disabilities and Special Needs (DDSN) The Unit receives reports from a toll-free number (1-866-200-6066) which is answered twenty-four hours a day, seven days a week at SLED headquarters. The toll-free number is posted in all DMH and DDSN facilities.

  26. When the Unit receives an allegation of abuse, neglect, or exploitation of a vulnerable adult in a facility operated by the DMH or DDSN then SLED’s Vulnerable Adult Investigative Unit will investigate. Prior to the law bring changed in 2006, these agencies investigated themselves. SLED signed Memorandum of Agreements with DMH and DDSN to assume investigative authority within their jurisdiction to investigate staff on patient/consumer crimes. When the Unit receives an allegation of abuse, neglect, or exploitation of a vulnerable adult in a facility contractedby the DMH or the DDSN then SLED’s Vulnerable Adult Investigative Unit will coordinate and refer the case to the appropriate local law enforcement agency for investigation.

  27. SLED VULNERABLE ADULT INVESTIGATION UNIT 24-HOUR TOLL-FREE NUMBER SLED VULNERABLE ADULT INVESTIGATIONS INVESTIGATES OR COORDINATES REPORTS OF ABUSE, NEGLECT OR EXPLOITATION OF VULNERABLE ADULTS IN DMH OR DDSN FACILITIES. SLED VULNERABLE ADULT FATALITY INVESTIGATIONS INVESTIGATES ALL DEATHS IN DMH AND DDSN FACILITIES. INVESTIGATES OR COORDINATES THE INVESTIGATION OF SUSPICIOUS OR UNEXPECTED VULNERABLE ADULT FATALITIES IN COMMUNITY. S.C. ATTORNEY GENERAL’S OFFICE INVESTIGATES ALL FINANCIAL EXPLOITATION CASES IN FACILITIES. ALSO, INVESTIGATES AND PROSECUTES ABUSE, NEGLECT, AND EXPLOITATION AT NURSING HOMES AND COMMUNITY RESIDENTIAL CARE FACILITIES. LOCAL LAW ENFORCEMENT INVESTIGATES ‘RESIDENT ON RESIDENT’ ABUSE IN FACILITIES, AND ASSISTS OTHER INVESTIGATIVE ENTITIES IN THE INVESTIGATION OF ALLEGED REPORTS OF ABUSE, NEGLECT AND EXPLOITATION. S.C. LONG TERM CARE OMBUDSMAN INVESTIGATES NON-CRIMINAL REPORTS OF ALLEGED ABUSE, NEGLECT, AND EXPLOITATION TO INCLUDE BUT NOT LIMITED TO STANDARD OF CARE AND QUALITY OF LIFE ISSUES OCCURRING IN FACILITIES. D.S.S. ADULT PROTECTIVE SERVICES INVESTIGATES NON-CRIMINAL REPORTS OF ALLEGED ABUSE, NEGLECT AND EXPLOITATION OF VULNERABLE ADULTS OCCURRING IN ALL SETTINGS (IN COMMUNITY) OTHER THAN THOSE FACILITIES FOR WHICH THE LONG TERM CARE OMBUDSMAN PROGRAM IS RESPONSIBLE . SLED INVESTIGATIVE SERVICES INVESTIGATES ANY OTHER TYPE OF INVESTIGATION DEEMED NECESSARY TO INCLUDE BUT NOT LIMITED TO CRIMES INVOLVING STATE EMPLOYEES AND CRIMES AT STATE FACILITIES.

  28. “Case Status Report” We respectfully request that that law enforcement complete this form in order to maintain an updated database in the VAIU. The form can be mailed or faxed to SLED. The information is vital for tracking trends at facilities and employees with more than one offense.

  29. The unit will refer non-criminal reports of alleged abuse, neglect, and exploitation of vulnerable adults, to include but not limited to, standard of care and quality of life issues to the Long Term Care Ombudsman Program for investigation. The unit will refer cases that are non-criminal reports of alleged abuse, neglect, and exploitation of vulnerable adults in all settings (in community) other than those facilities for which the Long Term Care Ombudsman Program is responsible to the Department of Social Services Adult Protective Services Program.

  30. SECTION 43-35-75. Immunity of person making report or participating in investigation in good faith. (A) A person who, acting in good faith, reports pursuant to this chapter or who participates in an investigation or judicial proceeding resulting from a report is immune from civil and criminal liability which may otherwise result by reason of this action. In a civil or criminal proceeding good faith is a rebuttable presumption. (B) It is against the public policy of South Carolina to change an employee's status solely because the employee reports or cooperates with an investigation or action taken under this chapter.

  31. SECTION 43-35-85: (G) A person who threatens, intimidates, or attempts to intimidate a vulnerable adult subject of a report, a witness, or any other person cooperating with an investigation conducted pursuant to this chapter is guilty of a misdemeanor and, upon conviction, must be fined not more than five thousand dollars or imprisoned for not more than three years.

  32. The Vulnerable Adults Death Investigations Unit is tasked with investigating the death of a vulnerable adult.

  33. Alldeaths occurring in a facility operated or contracted for operation by DMH or DDSN must be referred to the Vulnerable Adults Death Investigations Unit.

  34. The Unit reports its findings related to vulnerable adult deaths to the Vulnerable Adults Fatalities Review Committee which meet every other month. The members of the Vulnerable Adults Fatalities Review Committee are as follows:

  35. South Carolina Department of Social Services (DSS) • Department of Health and Environmental Control (DHEC) • South Carolina Criminal Justice Academy (SCCJA) • SLED • SC Department of Alcohol and Other Drug Abuse Services (DAODAS) • Department of Mental Health • Department of Disabilities and Special Needs • Director of the Office on Aging • Protection and Advocacy for People with Disabilities • two (2) representatives from two county boards of disabilities and special needs • a county coroner or medical examiner • an attorney with experience in prosecuting crimes against vulnerable adults • a physician with experience in treating vulnerable adults • a solicitor • a forensic pathologist • two (2) members of the public at large • one of whom must represent a private nonprofit community residential care facility and one of whom must represent a public for profit community residential care facility, both of which must provide services to vulnerable adults.

  36. Penalty – Failure to Report 43-35-85 (A) Elements: Mandatory reporter under 43-35-25 and Actual knowledge 43-35-25 (C) A person required to report pursuant to this section is personally responsible for making the report… Punishment: Up to 1 year in jail or fine up to $2,500 Simple Abuse (no serious injury): Defined at 43-35-85(B) Elements: Knowingly and willfully abuse a vulnerable adult Punishment: Up to 5 years Classification: Felony

  37. Abuse resulting in great bodily injury Defined at 43-35-85-(E) Elements: Knowingly and willfully abuse a vulnerable adult resulting in “great bodily injury” as defined at 43-35-85. Punishment: Up to 15 years Classification: Felony Abuse resulting in death Defined at 43-35-85 (F) Elements: Knowingly and willfully abuse a vulnerable adult resulting in death. Punishment: Up to 30 years Classification: Felony

  38. Statistics as of January 2010 Incident Intakes by Region 2007 2008 2009 Low Country 185 209 208 Midlands 411 390 301 Pee Dee 113 119 110 Piedmont 345 314 332 Unknown 0 0 3 Total: 1,054 1,032 954

  39. VAIU Intake Report – All intakesby Incident Type 2007 2008 2009 Exploitation 17 11 13 Failure to Report 5 3 2 Fatality 257 343 346 Financial Exploitation 43 17 14 Neglect 66 30 27 Other 83 133 146 Physical Abuse 360 280 171 Sexual Abuse 47 41 20 Standard of Care 95 83 127 Verbal Abuse 81 91 88 Total 1,054 1,032 954

  40. Incidents by Type of Facility 2007 2008 2009 Assisted Living Facility 1 Community Residential Care Facility 50 35 31 CTH-I 10 5 7 CTH-II 286 275 264 Day Program 35 42 30 DMH Homeshare Facility 2 2 4 Hospital 0 7 2 ICF/MR 150 141 156 Nursing Care Facility 214 278 272 Private Facility 57 55 47 Private Residence 25 37 23 Psychiatric Hospital 138 96 55 Public Place 0 0 3 Regional Residential Facility 50 33 27 SLP-I 7 11 9 SLP-II 26 14 11 Unknown 0 0 13 Work Activity 4 0 0 Total 1,054 1,032 954

  41. Incidents by Type Facility 2007 2008 2009 A - DMH 375 382 349 B - DDSN 578 547 528 C - Private Facilities/Residences 101 103 77 Total: 1,054 1,032 954

  42. Number of Incidents Referred to 2007 2008 2009 AG’S OFFICE 35 11 8 DSS-APS 35 30 33 LLE Agency 261 213 122 Non-VAIU 115 131 106 Other 0 3 15 SLED VAIU 428 452 411 SLTCOP (Ombudsman) 180 192 259 Total 1,054 1,032 954

  43. Our goal is to investigate or assist in the investigation of those persons who are unable to defend for themselves and to make South Carolina a safer and healthier place for vulnerable adults. We thank you for your assistance and support for this most noteworthy endeavor.

  44. Captain Patsy Lightle SAC Special Victims Unit 803-896-7654 Lieutenant Howell “Holly” Siniard SSA VAIU 803-896-2650 Lieutenant Carolyn Davis SSA Adult Fatality 803-896-0281

  45. SeniorSpecial Agent Melody Wright VAIU/Adult Fatality 803-896-7949 Special Agent Charles “Matt” Brown VAIU/Adult Fatality 803-896-0275 Special Agent Candy Atkins VAIU/Adult Fatality 803-896-7654 Special Agent Jonathan “Jon” Campbell VAIU/Adult Fatality 803-896-7654 Special Agent Ted Kennedy VAIU/Adult Fatality 803-896-7654 Special Agent Edgar Stagger VAIU/Adult Fatality 803-896-7654 Special Agent Henry “Hank” Harrison VAIU Adult Fatality 803-896-7436

  46. Complaint Investigations and Reporting Guidelines SC DHEC

  47. What Is A Reportable Incident? • Alleged Abuse • Alleged Neglect • Involuntary Seclusion • Alleged Misappropriation of Property • Injury of Unknown Source

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