Analysis

Topic: Reporting and investigation of patient abuse, neglect
SPONSOR: Rep. Anthony et al
HOUSE/SENATE COMMITTEE: Health Policy

POSITION: The Department does not have a formal position but does have several concerns about the bill.

PROBLEM/BACKGROUND: The bill is intended to amend Section 21771 of the Public Health Code to strengthen the types of events reported and the subsequent investigation, reporting and hearing provisions in that section of the code.

DESCRIPTION OF THE BILL: The bill:

1) amends Section 21771(1) to specifically include nurse aides as employees of the home and to add misappropriation of personal property of a patient as a prohibited act.

2) makes technical amendments to 21771(2) and (4).

3) amends Section 21771(5) by adding specific reference to the Social Security Act as the authority for investigations, and requiring investigations to commence within 10 days and be completed within 30 days.

4) adds Section 21771(6) which requires notification to the alleged individual within 10 days of the completion of the investigation, with a copy to the nursing home.

5) adds Section 21771(8) which requires a contested case hearing under authority of the Social Security Act. The department is to be a party to the hearing and be represented by the Attorney General.

6) adds Section 21771(9) which requires notice to the individual of the hearing results and notification to the nurse aide registry if appropriate.

SUMMARY OF ARGUMENTS:
Pro: The bill purports to amend Section 21771 to strengthen the types of events reported and the subsequent investigation, reporting and hearing provisions.

Con:
1) Section 21771(2) refers to the department of community health; this should be changed to the department of consumer and industry services. It also provides for departmental referral to the FIA; this is unnecessary and duplicative since the Adult Protective Services Act (PA 519 of 1982) requires health professionals and employees of health care facilities to report such events to the FIA. However, it would be appropriate to require department referrals to the Attorney General since the department currently does so under interagency agreement.

2) Section 21771(5) requires the department to commence investigation within 10 days of receipt regardless of the seriousness of the allegation. The department currently utilizes a prioritization system for reports in which serious events are investigated within 24 hours. Less serious events are investigated within a time frame of up to 45 days, and integrated with the overall survey of the home, if possible, to obtain a more thorough evaluation of the specific allegations as well as the overall issue for all residents who may be subject to similar problems.

3) Section 21771(8) requires a contested case hearing in which the department is a party and representation by the Attorney General. In the case of a facility-reported incident, the department expects a home to immediately conduct its own investigation of events and to determine if there is reasonable cause to suspect abuse or misappropriation may have occurred, and to provide documents of its investigation, and report it's findings. If the department is not satisfied with the home's investigation for any reason it proceeds with its own investigation to supplement the home's investigation. In the case of a non-facility complaint, the department conducts an investigation, and notifies both the facility and the complainant of its determination. While the department may conduct an investigation in both instances, the primary dispute is between the facility and the complainant as to whether the complaint is valid, and the facility should remain the primary respondent-party. The current system, which makes the complainant and the facility parties, has allowed the informal resolution of the vast majority of cases involving dissatisfied complainants, and should be continued. The department should be required to reinvestigate if the hearing officer so rules, but should not be a party.

SUPPORTERS/PROPONENTS: No information is available at this time.

FISCAL INFORMATION: (If applicable)

Requiring commencement of all investigations within 10 days would necessitate additional survey staff.

ECONOMIC IMPACT: (If applicable)