Current through all regulations passed and filed through March 18, 2024
(A) The public children services agency
(PCSA) shall 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 shall initiate the screened in
medical neglect report in accordance with the following:
(1) Complete 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 as a report.
(2) 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:
(a) The physical location of the disabled
infant within the hospital, e.g., emergency room, neonatal intensive care unit,
labor and delivery, sixth floor, etc.
(b) The disabled infant's age.
(c) The disabled infant's diagnoses or
diagnosis and the prognosis.
(d)
The
medical
condition requiring treatment.
(e) The immediate actions necessary to keep
the disabled infant alive.
(f)
Whether or not the withholding of life-sustaining treatment has been
recommended.
(g) Whether or not the
withholding of life-sustaining treatment has been implemented.
(h) Whether or not the parent, guardian, or
custodian has refused to consent to life-sustaining treatment.
(i) Whether or not the hospital chose to
sustain life-supporting care for the immediate future, preceding ninety-six
hours from the date and time the PCSA initiated the report, while the
assessment/investigation is underway.
(j) 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 shall document in the case
record the date, time, and with whom the assessment/investigation was
initiated.
(D) The PCSA shall
involve a qualified medical consultant within twenty-four hours from the time
the referral was screened in as a report to assist in the evaluation of the
disabled infant's medical information, including medical records, obtained
during the preliminary medical assessment.
(E) If the PCSA determines the child to be in
immediate danger of serious harm, the PCSA shall follow procedures outlined in
rule
5101:2-37-02
of the Administrative Code.
(F)
The PCSA shall 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.
(G) The PCSA shall
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 as a report. 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.
(H) If the
attempted face-to-face contact with the disabled infant's parent, guardian, or
custodian as specified in paragraph (G) of this rule is unsuccessful, the PCSA
shall continue making attempts of face-to-face contact at least every five
working days until face-to-face contact occurs or until the PCSA is required to
make a report disposition pursuant to paragraph (O) of this rule.
(I) The PCSA shall complete the JFS 01401
"Comprehensive Assessment Planning Model - I.S., Safety Assessment" (rev.
2/2006) pursuant to rule
5101:2-37-01
of the Administrative Code within four working days from the date the report
was screened in.
(J) The PCSA shall
document in the case record the date and time of the contact, or attempted
contacts.
(K) The PCSA shall, 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 has 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.
(L) The PCSA shall 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 his or her knowledge of
the allegation.
(M) The PCSA shall
advise the alleged perpetrator of the allegations made against him or her 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.
(N) The PCSA shall 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 shall
exercise discretion in the selection of collateral sources to protect the
privacy of the principals of the report.
(O) The PCSA shall complete the report
disposition and arrive at a final case decision by completing the JFS 01400
"Comprehensive Assessment Planning Model - I.S., Family Assessment" (rev.
7/2006) no later than forty-five days from the date the PCSA screened in the
referral as a child abuse and/or neglect report. The PCSA may extend the time
frame by a maximum of fifteen days if information needed to determine the
report disposition and final case decision cannot be obtained within forty-five
days and the reasons are documented in the case record pursuant to rule
5101:2-36-11
of the Administrative Code.
(P) The
PCSA shall not waive the completion of the report disposition.
(Q) The PCSA shall have an interpreter
present for all interviews if the PCSA has determined that a principal of the
report has a language or any other impairment that causes a barrier in
communication, including but not limited to a principal of the report who is
deaf or hearing impaired, limited English proficiency or is developmentally
delayed.
(R) Within two working
days of completion of the assessment/investigation, the PCSA shall notify the
alleged perpetrator in writing of the report disposition and the right to
appeal the disposition pursuant to rule
5101:2-33-20
of the Administrative Code.
(S)
Within two working days from the date of the completion of the report
disposition, the PCSA shall notify the disabled infant's parent(s) in writing
of the report disposition and case decision.
(T) No later than three working days from the
date of the completion of the report disposition, the PCSA shall 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.
(U) The PCSA
shall 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.
(V) The PCSA shall
maintain all materials obtained as a result of the assessment/ investigation in
the case record.