Public Comment -
Guidance for Serious Incident Reporting

Document ID:  LIC 17

Overall General Comment: 

This is general comment indirectly related to this guidance document.  There are two sides of CHRIS – a Licensing side and a Human Rights side.  Sometimes a report is required on the OL side, sometimes on the OHR side, and sometimes the same report must be entered separately in both sides of CHRIS.  OL has issued this guidance document and conducts almost-monthly on-line training sessions (that historically and routinely have technical difficulties prohibiting full provider participation).  OHR has no guidance document and conducts periodic in-person regional trainings.  Requests:

• OL and OHR work to reprogram CHRIS so that no incident must be entered twice but is visible on both sides when a selection is made for that option.
• OL and OHR collaborate to produce one guidance document which defines requirements for both sides of CHRIS and addresses requirements for reporting in each and in both sides.
• OL and OHR collaborate to produce joint trainings to cover reporting on both sides of CHRIS.
• DBHDS resolve the technical difficulties that have plagued on-line CHRIS trainings for many months without resolution, and which routinely impact other DBHDS staff’s on-line trainings and presentations as well.  Note that OL recently changed to a Zoom platform for its latest CHRIS training, but technical difficulties arose then too. 

12VAC35-105-20 - Definitions

Page 3 - “Level II serious incidents”

#3 – An emergency room or urgent care facility visit when not used in lieu of a primary care physician visit:
In a recent OL training session on Licensing Regulations/Final DOJ Regs/October 2020, it was clarified that if 911 is called and EMTs recommend transport to the ER, but the individual or SDM declines to go to the ER, UC, or to see a physician, then the incident is not a Level II and a CHRIS report is not required.  We request that this clarification be added to the guidance document. 

12VAC35-105-160.E
Page 9 - 160.E (i) Is this an oversight? Regulation states that providers are no longer required to complete a Root Cause Analysis if the Level III incident did not occur during the provision of a service or on the provider’s premises.  However, the proposed guidance document in 12VAC35-105-160.E (i) states: “In the case of a Level III incident that did not occur while the individual was receiving active services from the provider, or on the provider’s premises, this documentation should include as much information as was reported to, or is otherwise known by the provider.”

A provider would include this information in a CHRIS report but not a Root Cause Analysis according to the regulations.

Agree with Comment posted by Jennifer Fidura, VNPP

The expectations of the Guidance Document on Serious Incident Reporting appear to exceed the regulations.

“The definition of a "Level II" incident is "a serious incident that occurs or originates during the provision of a service or on the premises of the provider."  The "guidance" expands that definition for a class of providers who provide residential service based on the assumption that 24 hour "support" includes exclusive services provision.  The second sentence of that definition is, "Residential services provide a range of living arrangements from highly structured and intensively supervised to relatively independent requiring a modest amount of staff support and monitoring."  The expectation that a residential provider is responsible to "verify" that another licensed provider has reported appropriately a Level II incident which occurred while they were providing service is both outside of their role and responsibility and requires an statement of fact that can not, by the provider, be verified. 

I note that you do not include in your guidance any reference to the responsibility for reporting any incident which may have occurred while with family for the weekend, or while in the hospital.  A trip to the store, part of the Support Plan, and therefore part of the service would seem to fall under the category of "during the provision of service." If the incident does not occur during the provision of services or on the provider's premises, there can not be any obligation/responsibility for reporting."