Attachment 25 - SWS MCM 11-94 Mandatory Reporting.pdf

VA SAN DIEGO HEALTHCARE SYSTEM MEMORANDUM 11-94

SAN DIEGO, CA March 15, 2018

MANDATORY REPORTING OF SUSPECTED ABUSE OF CHILDREN,

ELDERS AND DEPENDENT ADULTS

1. PURPOSE: To establish policy and procedures for the reporting of abuse or suspected abuse of children to the local Department of Child Welfare Services, and of elders and dependents to the local department of Aging and Independent Services (AIS).

2. POLICY: It is the policy of the VA San Diego Healthcare System (VASDHS) to cooperate with all law enforcement agencies, including State, County, and Local government departments that are charged by law with the protection of public health and safety. Those persons legally mandated to report suspected abuse of children shall not be civilly or criminally liable for any report required under California Penal Section 11172 (a). Any other person reporting a suspected instance of child abuse shall not incur civil or criminal liability as a result of any report unless it can be proved that a false report was made and the person knew or should have known that the report was false. The identity of those persons who report the abuse of elders and dependent adults is confidential and is disclosed only between adult protective services agencies, local law enforcement agencies, long-term care ombudsman coordinator, licensing agencies, the District Attorney in criminal prosecution or upon waiver of confidentiality by the reporter, or by court order.

3. DEFINITIONS:

a. Health Care Personnel: A physician, physician’s assistant, , psychologist, dentist, resident, podiatrist, advanced practice nurse, registered nurse, dental hygienist, social worker, marriage and family therapist, paramedic, optometrist, audiologist, psychological assistant, chaplain, law enforcement officer, or any other person who is currently licensed or registered under the California Business and Professions Code. Health care personnel are mandated by law to report suspected child and elderly or dependent abuse.

b. Child Protective Agency (CPA): A police or sheriff’s department, a county probation department, or a county welfare department.

c. Child: A person under the age of eighteen (18).

d. Child Abuse: A physical injury, which is a non-accidental injury, to a child inflicted by a related or non-related person (adult or child). Also includes emotional abuse, sexual abuse, neglect or abuse in out-of-home care. Under the law, when the victim is a child, and the perpetrator is any person (including a child), the following types of abuse must be reported by all legally mandated reporters:

1) Physical abuse: The willful infliction of any cruel or inhuman corporal punishment or injury on a child by another person. Spanking that is reasonable and age-appropriate and does not expose the child to risk of significant injury is not considered child abuse.

2) Child sexual abuse/exploitation, which includes both sexual assault and sexual exploitation. Sexual assault includes sex acts with children, and intentional masturbation in the presence of children.

Sexual exploitation includes, accessing preparing, selling or distributing pornographic materials involving children, performances involving obscene sexual conduct and child prostitution.

3) Willful harming or injuring of a child or the endangering of the person or health of a child, including inflicting or permitting unjustifiable physical pain or mental suffering, or the endangerment of the child’s person or health.

4) Emotional abuse, which includes fear, harassment, intimidation, isolation, threats, verbal assaults, and the withholding of emotional support.

5) Neglect, including acts or omissions harming or threatening to harm the child’s health or welfare. Neglect, whether severe or general, must be reported if the perpetrator is a person responsible for the child’s welfare. Examples are: denial of basic needs (e.g., food, clothing, shelter); failure to assist with personal hygiene; failure to prevent malnutrition; failure to protect from health or safety hazards; and failure to provide medical care for physical and mental health needs.

6) Reasonable suspicion occurs when it is objectively reasonable for a person to entertain a suspicion, based upon facts that could cause a reasonable person in a like position, drawing when appropriate on his or her training and experience, to suspect child abuse.

e. Elder: A person 65 years of age or older.

f. Dependent adult: A person between the ages of 18 and 64 who has physical or mental limitations which restrict his or her ability to carry out normal activities or to protect his or her rights. This includes any person between the ages of 18 and 64 who is admitted as an inpatient to a 24-hour health facility.

g. Elder and dependent abuse: The willful harming and injuring of an elder or dependent adult, or the endangering of the person or health of the person including but not limited to:

1) Physical Abuse: Direct physical harm;

a) Improper or unreasonable physical or chemical restraint, medication or isolation without authorization or for a purpose other than for which it was ordered, such as for staff convenience, for punishment, or for a period beyond that for which it was ordered;

b) Lack of food or water; and

c) Threat of physical harm.

2) Neglect: Negligent failure to exercise that degree of care which a reasonable person in a like position would exercise, including but not limited to:

a) Denial of basic needs - food, clothing, shelter;

b) Failure to assist with personal hygiene;

c) Failure to prevent malnutrition;

d) Failure to protect from health or safety hazards; and

e) Failure to provide medical care for physical and mental health needs (except where there is reliance on spiritual means through prayer alone).

3) Emotional Abuse: Includes harassment, intimidation, isolation, actions causing fear, withholding therapy for severe depression, being subject to agitation, threats, verbal assaults, and the withholding of emotional support.

4) Fiduciary Abuse: Occurs in a situation where any person who stands in a position of trust willfully steals or appropriates the money or property of an elderly or dependent adult for any use or purpose not in the due or lawful execution of his or her trust. It includes extortion, fraud, theft, and the misuse of funds or property.

5) Abandonment: The desertion or willful forsaking of an elderly or dependent adult by anyone having care or custody of that person under circumstances in which a reasonable person would continue to provide care and custody.

6) Sexual Abuse: Includes incest, oral copulation, penetration, rape, sexual assault, sexual battery, and sodomy which occur without the consent of a person, or when the person is not capable of giving consent.

4. RESPONSIBILITIES:

a. All health care personnel employed in either paid or without compensation positions by VASDHS are considered “mandated reporters” of child and elder or dependent abuse. By law, all health care personnel must report abuse when s/he has knowledge of, reasonably suspects, or observes a victim of abuse. The report must be made to the appropriate agency. Persons legally required to report suspected child abuse have immunity from criminal or civil liability for reporting as required. Also, the identity of those persons who report the abuse of elders and dependent adults is confidential and is disclosed only between adult protective services agencies, local law enforcement agencies, long-term care ombudsman coordinator, licensing agencies, the District Attorney in criminal prosecution or upon waiver of confidentiality by the reporter, or by court order.

b. Any person, not mandated by law to report suspected child abuse, who does so, has immunity unless the report is proven to be false and the person reporting knows it is false, or the report is made with reckless disregard of the truth or falsity of the incident.

c. The health care personnel receiving the first-hand communication should initiate the report and contact the Social Work Service (858-642-3671 or 858- 642-3500). Social Work is responsible for coordinating the reporting of abuse during working hours by providing the appropriate phone numbers, forms, and guidance to the health care practitioner. A copy of the report will also be sent to the main Social Work Office (mail code 122). The social worker is responsible for determining the need for follow-up and making appropriate referrals to other follow-up personnel or agencies, and documenting all actions taken in the medical record.

d. The Medical Administrative Officer of the Day (MAOD) is responsible for coordinating the reporting of abuse during off-tours by providing the appropriate phone numbers and forms to the health care practitioner (858- 552-4344). The MAOD will ensure that the form is given to Social Work Service on the next regular administrative work day.

e. All health care personnel who have knowledge of or reasonably suspect that other types of abuse described above have been inflicted upon an elder or dependent adult or that his or her emotional well-being is endangered in any other way, may report such known or suspected instance of abuse to a long-term care ombudsman coordinator when the abuse is alleged to have occurred in a long-term care facility, or to the County Adult Protective Services agency when the abuse is alleged to have occurred anywhere else.

5. PROCEDURES:

a. Reporting of Child Abuse:

1) Telephone reports must be made immediately, or as soon as possible, by the health care personnel who has observed or suspects the alleged abuse. Within San Diego County, the telephone number to report child abuse is (800) 344-6000 or (858) 560-2191, and to report within Imperial County, the telephone number is (760) 337-7750.

2) A written report of the alleged abuse must be made by health care personnel within 36 hours using form SS 8572 “Suspected Child Abuse Report,” with a copy filed in the Veteran’s administrative file and a copy sent to the attention of Social Work Service (122) for purposes of follow-

up. Forms used to report Suspected Child Abuse are available in the main Social Work Service Office and in the Emergency Department, office of the MAOD, or can be found at:

https://oag.ca.gov/sites/all/files/agweb/pdfs/childabuse/ss_8572.pdf

Completed reports are mailed to the Child Abuse Hotline, P.O. Box 711341, San Diego, CA 92111 or faxed to (858) 694-5240 or (858) 694- 5241. For Imperial County, reports are mailed to Imperial County CWS https://oag.ca.gov/sites/all/files/agweb/pdfs/childabuse/ss_8572.pdf

Agency, 2995 South 4th Street, Suite 102, El Centro, CA 92243 or faxed to (760) 337-5070.

3) During working hours, 07:00 to 23:00, a social worker may be contacted to provide health care personnel with guidance in making the telephone report, completing the form and ensuring that the form is submitted to the appropriate agency. The healthcare personnel may call the main social work office (858 642-3671 or 858 642-3500), their regular clinic/unit social worker, or the Emergency Department social worker (weekdays between 17:00-23:00, or weekends 07:00 to 23:00, 858 642- 6316). During off-tours health care personnel should telephone in the report, complete Form SS 8572 and leave the form with the MAOD (858 552-4344) who will ensure that the form is submitted to Social Work Service on the next regular administrative work day.

4) When the conduct involves criminal activity, it should be reported immediately to VA Police Service who will then report to the appropriate law enforcement agency.

b. Reporting of Elder and Dependent Abuse:

1) Assessment & Documentation:

a) If the abuse is of a physical nature, the results of a physical exam, indicating abuse, should be documented completely in the patient's chart, including corroborating statements and pertinent psychosocial information.

b) After obtaining patient's written consent, photographs of the injuries should be taken and attached to the patient's 10-10M or physical exam.

c) Any evidence of physical abuse should be labeled and given to Police and Security Service.

2) Mandated reports of abuse must be made immediately or as soon as possible by telephone, by the health care personnel who has observed or suspects the alleged abuse. Within San Diego County, the telephone number to report elder and dependent adult abuse is 1-800-510-2020, and to report within Imperial County, the telephone number is (760) 337- 7878.

a) When the alleged abuse has occurred in a long-term care facility, e.g., board and care, residential care, intermediate care, or skilled nursing facility, the report should be made by calling the Long-term Care Ombudsman at 1-800-640-4661.

b) When the conduct involves criminal activity, it should be reported immediately to VA Police and Security Service who will then report to the appropriate law enforcement agency.

3) A written report of the alleged abuse must be made by health care personnel within 48 hours using form SOC 341 with a copy filed in the Veteran's administrative file and a copy sent to the attention of Social

Work Service (122) for purposes of follow-up. The APS report will be scanned into the patient’s record by Health Information Management Service. The Forms used to report suspected elder and dependent adult abuse are available in the Main Social Work Service Office and in the Emergency Department, office of the MAOD, or can be found at:

http://www.cdss.ca.gov/cdssweb/entres/forms/English/SOC341.pdf

Completed reports are mailed to Health and Human Services Agency/Aging and Independence Services 5560 Overland Ave, San Diego, CA 921123, or faxed to (858) 495-5247. For Imperial County, reports are mailed to Adult Protective Services Agency, 2999 South 4th Street, El Centro, CA 92243 or faxed to (760) 336-8593.

4) During working hours, 07:00 to 23:00, a social worker may be contacted to provide health care personnel with guidance in making the telephone report, completing the form and ensuring that the form is submitted to the appropriate agency. The healthcare personnel may call the main social work office (858 642-3671 or 858 642-3500), their regular clinic/unit social worker, or the Emergency Department social worker (weekdays between 17:00-23:00, or weekends 07:00 to 23:00, 858 642-6316). During off-tours, the health care practitioner should telephone in the report, fill out the SOC 341 and leave the form with the Medical Administrative Officer of the Day (MAOD) (858 552-4344) who will ensure that the form is sent to Social Work Service on the next regular administrative work day.

5) If releasing the patient from the Emergency Department will likely result in further physical abuse, the patient should be admitted until the next administrative work day to permit further evaluation and planning by the team.

6) When the patient is returning to the same environment where the alleged abuse or neglect occurred, he/she will be referred for a home evaluation through a Home Health Agency.

7) When appropriate, the patient will be assisted with relocation to a more suitable placement.

6. REFERENCES:

a. “The California Child Abuse and Neglect Reporting Law: Issues and Answers for Mandated Reporters,” California State Department of Social Services, Office of Child Abuse Prevention, January 2005.

b. VHA Directive 2006-068, “Reporting of Abuse and Neglect,” September 4, 2012.

c. Joint Commission, 2009 Comprehensive Accreditation Manual for Hospitals, “Assessment of Patients."

7. REVIEW DATE: January 15, 2021.

http://www.cdss.ca.gov/cdssweb/entres/forms/English/SOC341.pdf

8. FOLLOW-UP RESPONSIBILITY: Chief, Social Work Service

9. RESCISSION: MCM 11-94 dated January 15, 2015.

10. DATE APPROVED BY MEC: May 2, 2018.

X Kathleen Kim, MD, MPH

KATHLEEN M. KIM, MD, MPH

CHIEF OF STAFF

Signed by: Kim, Kathleen M.

X Cynthia E. Abair

ROBERT M. SMITH, MD

DIRECTOR

Signed by: people