Current through all regulations passed and filed through September 16, 2024
(A) The public children services agency
(PCSA)
is
to conduct an assessment/investigation if a neglect report alleges the
withholding of medically indicated treatment from a disabled infant with a
life-threatening condition.
(1) The
withholding of medically indicated treatment is the refusal to provide
appropriate nutrition, hydration, medication or other medically indicated
treatment from a disabled infant with a life-threatening condition.
(2) Medically indicated treatment includes
the medical care most likely to relieve, or correct, the life-threatening
condition. Nutrition, hydration, and medication, as appropriate for the
infant's needs, are medically indicated for all disabled infants; as well as,
the completion of appropriate evaluations or consultations necessary to assure
that sufficient information has been gathered to make informed medical
decisions on behalf of the disabled infant.
(3) In determining whether treatment is
medically indicated, reasonable medical judgments made by a prudent physician,
or treatment team, knowledgeable about the case and its treatment possibilities
are considered. The opinions about the infant's future "quality of life" are
not to bear on whether or not a treatment is judged to be medically indicated.
Medically indicated treatment does not include the failure to provide treatment
to a disabled infant if the treating physician's medical judgment identifies
any of the following:
(a) The disabled infant
is chronically and irreversibly comatose.
(b) The provision of the treatment is futile
and will prolong dying.
(c) The
provision of the treatment would not be effective in ameliorating or correcting
all of the disabled infant's life threatening conditions.
(d) The provision of such treatment to the
disabled infant is inhumane.
(B) The PCSA
is to initiate
the screened in medical neglect report
by completing face to face
or telephone contact with the health care facility's administrator or designee,
within one hour from the time the referral was screened in and obtain the
following information from the health care facility's administrator, or
designee, regarding the current condition of the disabled infant, including but
not limited to:
(1)
The physical location of the disabled infant within the
hospital, e.g., emergency room, neonatal intensive care unit, labor and
delivery, sixth floor, etc.
(2)
The disabled
infant's age.
(3)
The disabled infant's diagnoses or diagnosis and the
prognosis.
(4)
The medical condition requiring
treatment.
(5)
The immediate actions necessary to keep the disabled
infant alive.
(6)
Whether or not the withholding of life-sustaining
treatment has been recommended.
(7)
Whether or not
the withholding of life-sustaining treatment has been
implemented.
(8)
Whether or not the parent, guardian, or custodian has
refused to consent to life- sustaining treatment.
(9)
Whether or not
the hospital chose to sustain life-suporting care for the immediate future,
preceding four days from the date and time the PCSA initiated the report, while
assessment/investigation is underway.
(10)
Whether or not
sustenance (food or water, whether given orally or through an intravenous or
nasogastric tube) or medication is being denied.
(C) The PCSA
is to document
in the case record the date, time, and with whom the assessment/investigation
was initiated.
(D) The PCSA
is to
involve a qualified medical consultant within twenty-four hours from the time
the referral was screened in to
assist in the evaluation of the disabled infant's medical information,
including medical records, obtained during the preliminary medical assessment.
(E) The PCSA
is to
attempt a face-to-face contact in order to conduct an interview with the
alleged disabled infant's parent, guardian, or custodian no later than twenty-
four hours from the time the referral was screened in
. The purpose of the interview
is to:
(1) Inform the parent, guardian, or
custodian that a neglect report alleging the withholding of medically indicated
treatment to a disabled infant has been accepted by the PCSA.
(2) Inform the parent guardian, or custodian
of the purpose of the assessment/investigation.
(3) Seek parental consent for medically
indicated treatment, if applicable.
(4) Confirm parent, guardian, or custodian's
name and identifying information.
(5) Determine if parent, guardian, or
custodian agrees on the course of action to be followed.
(6) Determine if the parent, guardian, or
custodian was presented with all treatment options by the medical treatment
team.
(7) Determine if the
prognosis of the disabled infant was presented to the parent, guardian, or
custodian.
(8) Assess if the
parent, guardian, or custodian understands the information provided by the
medical treatment team.
(9)
Determine the nature and degree of parental involvement in the decision to deny
treatment or sustenance to the alleged child victim, if applicable.
(10) Assess if appropriate counseling
services have been made available to the parent, guardian, or
custodian.
(11) Refer the parent,
guardian, or custodian to appropriate counseling services, if
applicable.
(12) Determine if the
parent, guardian, or custodian was provided information to facilitate access to
available services for disabled persons and family members.
(13) Assist the parent, guardian, or
custodian in accessing needed services, if applicable.
(14) Determine if the parent, guardian, or
custodian participated in the hospital review process.
(15) Determine if the parent, guardian, or
custodian was provided with or has access to the results of the hospital review
process.
(F) If the attempted
face-to-face contact with the disabled infant's parent, guardian, or custodian
as specified in paragraph (E) of this rule is unsuccessful, the PCSA shall
is to at minimum, continue making
face-to-face attempts at least every five working
days until any of the following occur:
(1)
Contacts are
made;
(2)
The parent, guardian, or custodian refuses contact and
the PCSA files a complaint in juvenile court; or
(3)
The PCSA needs to
make a report a dispostion pursuant to paragraph (O)(2) of this
rule.
(G) The PCSA
is to
complete the
" Safety
Assessment" pursuant to rule
5101:2-37-01 of the
Administrative Code within four working days from the date the report was
screened in.
(H)
If the PCSA determines the child to be in immediate
danger of serious harm, the PCSA is to follow procedures outlined in rule 5101:
2-37-02 of the Administrative Code.
(I)
The PCSA is to
pursue any legal remedies, including the initiation of legal proceedings in a
court of competent jurisdiction, to provide medical care or treatment for a
child if such care or treatment is necessary to prevent or remedy serious harm
to the child or to prevent the withholding of medically indicated treatment
from a disabled infant with a life-threatening condition.
(J) The PCSA
is to,
in cooperation with the medical consultant, conduct and document interviews
with the attending physician and health care facility staff. The purpose of the
interviews is to:
(1) Determine the measures
that the health care facility staff attending to the disabled infant
have taken
to provide medically indicated treatment to the disabled infant.
(2) Determine whether or not the disabled
infant's attending physician, with the consent of the disabled infant's parent,
guardian or custodian will sustain needed life-supporting care for twenty-four
hours while the PCSA continues the assessment/investigation.
(3) Determine if any of the following
conditions of and risk to the disabled infant were concluded by the attending
physician's and/or staff's assessment:
(a) The
disabled infant is chronically and irreversibly comatose.
(b) The provision of medical treatment will
merely prolong dying, not be effective in ameliorating or correcting all of the
disabled infant's life- threatening conditions, or otherwise be futile in terms
of the survival of the disabled infant.
(c) The provision of medical treatment will
be virtually futile in terms of the survival of the disabled infant and the
treatment itself under such circumstances will be inhumane.
(4) Verify if plans have been made
to convene a meeting of the health care facility review committee or to adopt
the recommendations of the appropriate health care facility review committee,
and the meeting has been held.
(5)
Confirm the disabled infant's age.
(6) Confirm the disabled infant's diagnoses
or diagnosis.
(7) Determine if the
disabled infant's life is endangered.
(8) Determine if the withholding of
life-sustaining treatment is recommended.
(9) Determine if the withholding of
life-sustaining treatment is implemented.
(a)
Identify the treatment necessary for the disabled infant's life or health being
denied.
(b) Determine if sustenance
(food or water, whether given orally or through an intravenous or nasogastric
tube) or medication is being denied.
(10) Determine if the parent, guardian, or
custodian refused to consent to life- sustaining treatment.
(11) Determine if the hospital will sustain
life-supporting care for the immediate future while the PCSA's
assessment/investigation is conducted, if applicable.
(12) Identify the treatment or sustenance
being provided to the disabled infant, if applicable.
(13) Determine if there is consensus
regarding the medical diagnoses among the treatment team.
(14) Document and identify if there were/have
been any differing opinions among the treatment team.
(15) Document the names of all medical
consultants involved including their qualifications/credentials.
(16) Determine which members of the treatment
team discussed the case with the parent, guardian, or custodian.
(17) Determine if a hospital review process
occurred.
(a) If applicable, document the
review process.
(b) If applicable,
document the recommendations.
(K) The PCSA
is to
conduct and document all face-to-face interviews with the alleged perpetrator,
unless law enforcement or the county prosecutor or medical consultant will
interview the alleged perpetrator pursuant to the procedures delineated in the
county child abuse and neglect memorandum of understanding, in order to assess
their
knowledge of the allegation.
(L) The PCSA
is to
advise the alleged perpetrator of the allegations made against
them at the time of the initial contact. The initial
contact between the PCSA and the alleged perpetrator of the report includes the
first face-to-face or telephone contact, whichever occurs first, if information
is gathered as part of the assessment/investigation process.
(M)
The PCSA
is
to conduct and document face-to-face or telephone interviews with any
person identified as a possible source of information during the
assessment/investigation to obtain relevant information regarding the safety of
and risk to the child. The PCSA is to exercise discretion in the selection of
collateral sources to protect the privacy of the principals of the
report.
(N)
The PCSA is to have an interpreter present for all
interviews if the PCSA has determined that a principal of the report has any
factor that causes a barrier in communication.
(O)
No later than
sixty calendar days from the date the PCSA screened in the referral, the PCSA
is to:
(1)
At
minimum, complete face-to-face contact and interview the family of the alleged
disabled infant residing in the home. Family includes all individuals pursuant
to rule
5101:2-37-03 of the
Administrative Code.
(2)
Complete the report disposition.
(3)
Arrive at a final
case decision by completing either:
(a)
The "Family Assessment" pursuant to rule
5101:2-37-03 of the
Administrative Code; or
(b)
The "Ongoing Case Assessment/Investigation" if the
neglect report involves a principal of the report who is currently receiving
ongoing protective services from the PCSA.
(P) The PCSA
may
not waive the completion of the report disposition.
(Q)
No later
than five business
days of
completion of the
report disposition, the PCSA
is to do all
of the following:
(1)
Notify the
alleged perpetrator in writing of the report disposition; the right to appeal
the disposition; and the PCSA's appeal process including time frames and the
method by which the alleged perpetrator may appeal the disposition as outlined
in rule
5101:2-33-20 of the
Administrative Code.
(2)
Notify the disabled infant's parent(s), guardian(s), or
custodian(s) of the report disposition and final case decision.
(R) No later than three
working days from the date of the completion of the report disposition, the
PCSA is
to provide written notification of the report disposition to the
following entities, as applicable, in accordance with rules
5101:2-33-21 and
5101:2-36-12 of the
Administrative Code.
(1) Administrator,
director, or other chief administrator of the health care facility.
(2) The owner or governing board of the
health care facility.
(3) The
appropriate licensing and supervising authorities of the health care
facility.
(S) The PCSA
is to
notify law enforcement if it is determined that the attending physician failed
to provide medically indicated treatment or failed to inform the disabled
infant's parent, guardian, or custodian of the available treatment
options.
(T)
The assessment/investigation documentation and any
materials obtained as a result of the assessment/investigation
are to be maintained in the case record.
If any information gathering activity cannot be
completed, justification and the approval of the director or the designee are
to be documented in Ohio's CCWIS in accordance with rule
5101:2-36-11 of the
Administrative Code.
