This document discusses various legal reporting requirements in healthcare including requirements around reporting child abuse, elder abuse, communicable diseases, births and deaths, suspicious deaths, sentinel events, and maintaining corporate compliance programs. It covers who should report different types of abuse, signs that may indicate abuse is occurring, requirements of data banks like the National Practitioner Data Bank, and the purpose of root cause analyses and compliance programs.

2. Chapter 13
Legal Reporting Requirements
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3. Child Abuse
An abused child is one who has suffered
intentional serious
mental, emotional, sexual, and/or physical
injury inflicted by a family or other person
responsible for the child's care. Some states
extend the definition to include a child
suffering from starvation.
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4. Child Abuse
Who Should Report
• How Do You Detect Abuse
• Good Faith Reporting
– Psychologist Immune to Liability
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5. Child Abuse – III
• Failure to Report Child Abuse
– Psychologist’s Failure to Report Abuse
– Nurse’s Failure to Document and Report
– Physician Entitled to Immunity
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6. Elder Abuse
Elder abuse is any form of mistreatment that
results in harm or loss to an older person. It
can involve:
– physical abuse
– sexual abuse
– domestic violence
– psychological abuse
– financial abuse
– neglect: failure to provide needed care
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7. National Center on Elder Abuse
The National Center on Elder Abuse
(NCEA), directed by the U.S. Administration
on Aging, is committed to helping
national, state, and local partners in the field be
fully prepared to ensure that older Americans
will live with
dignity, integrity, independence, and without
abuse, neglect, and exploitation.
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8. Signs of Elder Abuse – I
• Unexplained or unexpected death
• Development of "pressure sores“
• Heavy medication & sedation used in place of
adequate nursing staff
• Occurrence of broken bones
• Sudden emotional outbursts, agitation, or
withdrawal
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9. Signs of Abuse – II
• Bruises, welts, discoloration, burns, and so
on
• Absence of hair and/or hemorrhaging below
scalp
• Dehydration/malnourishment without illness
related cause
• Hesitation to talk openly
• Implausible stories
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10. Signs of Abuse – III
• Unusual or inappropriate activity in bank
accounts
• Signatures on checks & other written
materials that do not resemble patient's
signature
• Power of attorney given, or recent changes
or creation of a will, when person is
incapable of making such decisions
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11. Elder Abuse
Signs of Abuse – IV
• Missing personal belongings such as
silverware or jewelry
• An untreated medical condition
• Patient unable to speak for himself or
herself, or see others, without presence of
caregiver (suspected abuser)
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12. Preventing Abuse
Policies & Procedures
• Prohibition of mistreatment
• Description of reporting procedures regarding
alleged abuse
• Maintenance of evidence of alleged abuse
• Investigation of alleged abuse, & prevention of
further potential abuse while investigation is in
progress.
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13. Elder Abuse
Documentation – I
• Suspected abuse should be defined clearly &
objectively.
– Witnesses: Reporters of abuse must describe
statements made by others as accurately as
possible
• what actions were taken, by
whom, when, where, etc.
• Info should be included about how witnesses
may be contacted.
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14. Elder Abuse
Documentation – II
Photographs: It may be necessary to
photograph wounds or injuries.
• hospital emergency room or the police
department can be asked to photograph in
emergency situations.
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15. Communicable Diseases
• Reported to protect citizens from infectious
diseases
• Reporting required by statutes
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16. Births & Deaths
• Reportable by statute
• Necessary to maintain accurate census records
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17. Suspicious Deaths
• Referral to medical examiner
• Violent deaths
• Criminal activity
• Medical Examiner
• Determines cause of death
• Provides information for criminal
investigation
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18. Health Care Quality Improvement Act
of 1986
Authorizes the National Practitioner Data
Bank to collect & release information on the
professional competence & conduct of health
care practitioners.
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19. National Practitioner Data Bank - I
• Reporting requirements
• Required queries
• Required Report
• Data Bank Queries
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20. National Practitioner Data Bank - II
• Query Fees
• Data bank fees
• Penalties for failing to report
• Confidentiality of data bank information
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21. Incident Reporting
• Incident/Occurrence Reports Discoverable
• State Reportable Incidents
– Incidents that have resulted in a patient’s serious
injury or death
– events such as fire, loss of emergency
power, infection outbreaks, & strikes by
employees.
• Incident reports should not be placed in the medical
record.
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22. Sentinel Events - I
• Joint Commission Reportable “sentinel events”
include:
– Events that result in
• unanticipated death
• major permanent loss of function
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23. Sentinel Events - II
• Suicide
• Unanticipated death of a full term infant
• Infant abduction
• Rape
• Hemolytic transfusion reaction
• Surgery on the wrong patient or wrong body part
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24. Root Cause Analysis – I
A process for identifying the basic or causal
factors that underlie the variation in
performance including the occurrence or
possible occurrence of a sentinel event.
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25. Root Cause Analysis – II
• Thorough
• Credible
• Investigation involves general & special
causes
• Researching literature
• Searching for best practices
• . . . implementing & monitoring change
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26. Corporate Compliance Programs
Federal government’s initiative to investigate
& prosecute health care corporations for
criminal wrongdoing . . .
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27. Elements of a Corporate Compliance
Program
1. Establishment of policies & procedures
2. Appointment of a corporate compliance officer
3. Communication of program to employees
4. Implementation of program
5. Consistent enforcement
6. Provide for disciplinary action
7. Modify compliance program as necessary
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28. REVIEW QUESTIONS
1. What is child abuse?
2. Who should report child abuse?
3. Describe the signs of elder abuse.
4. Why was the Health Care Quality Improvement
Act of 1986 enacted?
5. Describe the purpose of the National
Practitioner Data Bank.
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29. REVIEW QUESTIONS, cont.
6. What is a sentinel event?
7. Discuss the process of conducting a root-cause
analysis.
8. Describe the basic elements of an effective
corporate compliance program.
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