OIG Rule 50 Training

OIG can provide a Rule 50 PowerPoint presentation for facilities and agencies to use to meet the biennial training requirement of Rule 50. Please send any requests for the presentation to DHS.OIG.Training@Illinois.gov

DHS Office of the Inspector General

Recognizing and Reporting Abuse and Neglect

The Office of the Inspector General for the Illinois Department of Human Services is the agency which investigates abuse and neglect allegations involving individuals who receive mental health and/or developmental disability services in a DHS State Operated Facility and/or community agencies.

Employees who commit acts of abuse or neglect are held accountable through the investigative process.

Every employee is required to report all allegations of abuse or neglect which they are made aware of.

Purpose of Training

The purpose of this training is to explain the definitions of abuse and neglect, how they are interpreted and applied, and to teach you how and when to report an allegation of abuse or neglect.

Department of Human Services Act 20 ILCS 1305/1-17

This act is the law which establishes OIG, defines abuse and neglect and establishes the reporting requirements for employees regarding reported, witnessed or suspected abuse or neglect. The law requires OIG to write an Administrative Rule which interprets and operationalizes the law.

Title 59, Chapter 1, Part of the Illinois Administrative Code is that Administrative Rule - otherwise known as Rule 50.

Training Requirements

Rule 50 requires that all employees must be trained in the requirements of Rule 50 upon hire and at least biennially thereafter - every two years. Completing this presentation meets this requirement.

Who qualifies as an employee?

An employee is defined in Rule 50 as any person who provides services at the facility or the community agency, on or off site. The service relationship can be with the individual, the facility or the agency.

This includes, but is not limited to, owners, operators, payroll personnel, contractors, subcontractors, and volunteers. 

An employee also includes any employee or contractual agent of SHA or the community agency involved in providing, monitoring or administering mental health or developmental disability services.

Even if the person is no longer working for an agency or facility, is considered an employee if they are the subject of an ongoing OIG investigation.

Examples of employees

In addition to the daily scheduled employee, the following job titles would be included as an employee if they are on site to provide services at the agency/facility:

• Landscaping company employees
• HVAC personnel servicing the furnace/air conditioning systems
• Hairdresser/barber cutting individuals' hair
• Vending company personnel filling vending machines
• Janitorial personnel cleaning the building
• Exterminators

As long as the person is providing a service to the individual, agency or facility and is allowed to be on site in the presences of individuals, they are considered employees under Rule 50.

Volunteers are also considered to be employees under Rule 50.

Allegations

To be reportable to OIG, an allegation or incident must involve an individual and an employee, agency or facility.

An individual is defined as any person receiving mental health services, developmental disabilities services, or both from a facility or agency while either on-site or off site.

OIG does not investigate allegations or incidents that are:

• Exclusively between employees
• Exclusively between individuals
  •  Unless the incident was caused by an employee or an employee is involved in the alleged incident.

So, what if...

After dinner at the CILA, Individual Claire reports that employee Charles slapped her on the hand earlier that day because she was "giving the finger" to her housemate Chloe because Chloe called her stupid. Is this reportable to OIG?

Yes - Because Claire is an individual who receives services in the CILA and Charles is an employee who was alleged to have abused an individual.

Remember...

For an allegation to be reportable to OIG, the victim must be an individual and the accused must be an employee, agency or facility.

Abuse

Rule 50 defines abuse as any:

• Physical Abuse
• Sexual Abuse
• Mental Abuse
• Financial Exploitation

Physical Abuse

Rule 50 defines physical abuse as an employee's non-accidental and inappropriate contact with an individual that causes bodily harm

Physical abuse also includes actions that cause bodily harm as a result of an employee directing an another individual or person to physical abuse another individual.

Bodily Harm

Rule 50 defines bodily harm as:

Any injury, damage, or impairment to an individual's physical condition, or - such as a bruise, cut, scrap or burn Making physical contact of an insulting or provoking nature with an individual.

The physical contact does not need to leave a mark.

So, what if...

When Clair was slapped on the hand by employee Charles, there was no injury. Is this a reportable incident?

Yes - the acting of slapping Claire's hand was non-accidental, inappropriate physical contact of an insulting or provoking nature. Also, the physical contact does not have to cause any type of mark or injury. Slapping without an injury is insulting and provoking.

Examples of Physical Abuse

• Pushing, hitting, slapping, or kicking an individual.
• Pulling an individual's hair; poking an individual in the chest with a finger; twisting an arm or ear; or an individual's finger, arm or neck.
• Snapping an individual with a towel, hitting them with a rubber band, or spitting on them.
• Man handling, roughing up, or stomping on their foot.

What is a required reporter? Are you one?

A required reporter is any employee who suspects, witnesses, or is informed of an allegation of physical abuse, mental abuse, sexual abuse, neglect or financial exploitation.

So, yes, you are a required reporter!

How to report an allegation to OIG

Allegations must be reported to the OIG via the OIG Hotline, within four (4) hours after the allegation is discovered.

This means if Claire told you about Charles slapping her hand at 6:00 p.m., then the allegation must be reported to the OIG Hotline by 10:00 p.m. that evening.

The OIG Hotline number is 800-368-1463 and is available 24 hours a day, 7 days a week, 365 days a year.

Your agency or facility may instruct you to report allegations through internal procedures. This is allowed, but the allegation must still be reported to OIG within four (4) hours of the time it was discovered. You are still a required reporter and should reported it as soon as possible, either through your agency's procedure or directly to the OIG Hotline - 800-368-1460

How not to report an allegation

• Putting an Incident Report in your supervisor's mailbox in their office so they will see it the next day.
• Sending your supervisor an email.

If you witness, are informed of or suspect an allegation of abuse at 10:00 p.m., then you must ensure it is reported to the OIG Hotline - 800-368-1460 - by 2:00 a.m., or it is considered a late report to OIG.

OIG Hotline

When you call 800-368-1463 during normal business days/hours, an OIG Intake Investigator will answer the phone and ask you questions to determine if the incident is an allegation per Rule 50 and meets the criteria to open an investigation. If the OIG Intake Investigator determines it is a reportable allegation, they will complete an OIG Intake Report and the investigative process will begin.

You will then have completed your responsibilities as a required reporter.

When you call 800-368-1463 after hours (approximately 4:45 p.m. to 8:30 a.m.) and on weekends and holidays, your call will be answered by the OIG Answering Service.

The OIG Answering Service will: 

• Take information about the incident, and 
• Tell you an OIG representative will call you back the next business day. 
• If you will not be available the next business day, someone at your facility/agency, who knows about the incident, must be available to complete the report in your place.

What if the police are needed?

If you need law enforcement assistance, contact them immediately.

Anytime there is credible evidence of a criminal act in a DHS State Operated Facility, OIG will contact the Illinois State Police (ISP). The facility can also call ISP directly if needed, but must notify OIG of this.

If the potential criminal act is at a community agency, the agency should contact the local police. Ensure to notify OIG that the local police have been contacted.

Should you report?

If you are unsure or only suspect abuse or neglect might have happened, should you report it?

Yes -  You do not have to know it happened or witnessed it to have happened to report the allegation. Even a suspicion of abuse or neglect should be reported. It is always best to report when you are unsure. Let OIG determine if the incident is reportable or not.

Should you Report?

You are told about an allegation that occurred a long time ago and you do not know if it was reported, should you report it?

Yes - Again, if you are unsure if something is reportable, report it. OIG will, and has, investigated allegations from 10 years ago. There is no statute of limitations or time limit on allegations that OIG investigates.

What is "Screening"?

Screening is withholding, altering or delaying any report of abuse or neglect to OIG.

Deciding not to report something because you know it did not happen or because if could not have happened as alleged is screening.

If anyone reports, complains or suspects abuse or neglect of an individual by an employee, facility or agency, you must report it no matter what the surrounding circumstances are or what you know about the incident.

What if you do not report an allegation?

• You could be disciplined.
• If you have a professional license or certification, it could be negatively affected.
• You could be charged with a crime. The law classifies willful or intentional failure to report an allegation of abuse or neglect as a Class A Misdemeanor, which is punishable by: 
  • Up to one (1) year in JAIL, and/or 
  • Up to a $2,500.00 fine.
• The failure to report allegations can also be handled administratively with some other form of corrective action.

Other considerations about reporting

You are violating the DHS Act if you:

• Create and transmit a false report to the OIG Hotline. 
• Cover up an allegation or evidence, or do not report an allegation. 
• Retaliate against someone who reports an allegation in good faith.

Besides physical abuse, what else is reportable?

You must also report any allegation of: 

• Mental Abuse 
• Sexual Abuse 
• Financial Exploitation 
• Neglect
• Certain deaths

What deaths are reportable to OIG?

If an individual dies on-site in any program of a DHS facility or any agency that is licensed, certified, or funded by DHS, like:

• Residential Facilities and CILAs 
• Community Day Services 
• Mental Health Out Patient Programs

It must be reported to OIG within 24 HOURS.

It is also reportable if the individual dies within: 

• 14 calendar days of discharge or transfer from the facility or agency, or 
• 24 hours of deflection from a residential program or facility.

What is deflection:

Deflection is when an individual comes to a facility or agency for admission or services but is not admitted or provided those services by staff. 

It does not matter why the individual was deflected, turned away or sent somewhere else.

If they die within 24 hours, it must be reported to OIG when you become aware of it.

If there is an allegation of abuse or neglect related to the individual's death, then it must be reported within four (4) hours of initial discovery to the OIG Hotline - 800-368-1463.

What if...

Tammy, an individual, returns to her residence after a home visit. Staff Terry takes her into the bathroom and makes her take off all her clothes to check for weapons or things that could harm herself or others. Tammy reports that Terry touches and rubs her all over when he completes this search and it makes her very uncomfortable. Tammy says Terry is the only one who does this when she comes home and she wonders why.

Is this sexual abuse?

Rule 50 defines sexual abuse as any sexual or intimate physical contact between an employee and an individual, including an employee's coercion or encouragement of an individual to engage in sexual behavior that results in sexual contact, intimate physical contact, sexual behavior or intimate physical behavior.

Sexual abuse

Sexual abuse also includes an employee's actions that result in the sending or showing of sexually explicit images to an individual via computer, cellular phone, electronic mail, portable electronic device, or other media with or without contact with the individual; or an employee's posting of sexually explicit images of an individual online or elsewhere whether or not there is contact with the individual.

Sexual abuse does not include allowing individuals to, of their own volition, view movies or images of a sexual nature, or read text containing sexual content unless the individual's guardian prohibits the viewing or reading of such materials.

Sexually explicit images include, but is not limited to, any material which depicts nudity, sexual conduct or sado-masochistic abuse, or which contains explicit and detailed verbal accounts or narrative accounts of sexual excitement, sexual conduct, or sadomasochistic abuse.

This does not include images contained in sex education materials used by employees to educate individuals.

Sexual Contact

According to Rule 50, sexual contact is inappropriate sexual contact between an employee and an individual involving either an employee's genital area, anus, buttocks or breasts or an individual's genital area, anus, buttocks or breasts.

Sexual contact also includes sexual contact between individuals that is coerced or encouraged by an employee.

So, is this sexual abuse?

Tammy is an individual and Terry is a staff member. Terry allegedly rubbed Tammy all over after he made her take all her clothes off.

Yes - This is an allegation of sexual abuse and should be reported within four (4) hours of discovery to the OIG Hotline 800-368-1463.

The investigation will determine if Terry engaged in sexual abuse/contact with Tammy.

A sexual abuse finding can be referred to law enforcement, and if the employee is charged criminally and convicted, it would be a Class 3 felony punishable by

• two to five years in prison, and
• a fine of up to $25,000.

Sexual Misconduct with a Person with a Disability 720 ILCS 5/11-9.5 )

This is a Class 3 felony and the victim's consent is not a defense.

In addition to prison time and a fine, it is also punishable by: 

• Mandatory registration as a sex offender and supervision for one year; 
• Immediate job lose; 
• Listing on the Illinois Department of Public Health - Health Care Worker Registry which prohibits working in the healthcare field in Illinois.

What if.....

Roberto, an individual, tells you that he wanted to take his own medicine and Robin, the nurse, said to him, "You retards are too stupid to take your own medicine. That is why they pay me to stand here and give it to you in a little cup." Roberto said he wanted to punch her, but did not.

Is this reportable?

Yes - Roberto is an individual and Terry is an employee who allegedly made the allegedly abusive comments to Roberto.

Mental Abuse

Mental abuse is the use of demeaning, intimidating or threatening words, signs, gestures or other actions by an employee about an individual and in the presence of an individual or individuals that results in emotional distress or maladaptive behavior, or could have resulted in emotional distress or maladaptive behavior, for any individual present.

Is it alleged Mental Abuse?

Robin is an employee and Roberto is an individual. Calling someone with a disability a "retard" and is "too stupid" is clearly demeaning. It resulted in Roberto feeling upset and wanting to physically lash out at Robin. Therefore, this is a reportable allegation of mental abuse and must be reported within four (4) hours of discovery.

What if in response to the alleged comments, Robert shrugged his shoulders and walked away?

Should you report this to OIG?

YES - His emotional distress or engaging in maladaptive behavior may not manifest itself until later. Just making the comments as alleged is enough to report and open an investigation.

There can be times when an individual, due to their disability, cannot understand what is being said to them or cannot show emotional distress or engage in maladaptive behavior. There also may be times when the individual would have responded with emotional distress or engaging in maladaptive behavior, but due to therapies learned and applied, chose not to engage in such behaviors or internalize the emotional distress.

These situations would be covered by the definition language of "could have resulted in emotional distress or maladaptive behavior."

OIG takes into account the individual's diagnosis or history when evaluating case and the individual is still a victim of alleged mental abuse.

Financial Exploitation

Financial exploitation is defined as the taking unjust advantage of an individual's assets, property, or financial resources through deception, intimidation or conversion (meaning theft) for the employee's facility's or agency's own advantage or benefit.

Financial Exploitation Examples

• Removing money from an individual's purse.
• Taking money from an individual's trust fund or bank account.
• Using and not returning an individual's property, such as clothing. 
• Taking an individual's food. 
• Coercing an individual to trade an items the employee wants.
• All of these would be reportable to OIG as financial exploitation. 

Neglect

Neglect is defined as an employee's, agency's or facility's failure to provide adequate medical care, personal care, or maintenance that, as a consequence: 

• Causes an individual pain, injury or emotional distress, or
• Results in either an individual's maladaptive behavior or deterioration of an individual's physical or mental condition, or
• Places an individual's health and safety at substantial risk.

Egregious Neglect

When an allegation of neglect is substantiated, the Inspector General will determine if it rises to the level of egregious neglect which is: 

• A gross failure to adequately provided for, or a callous indifference to, the health, safety, or medical needs of an individual, and 
• results in an individual's death or other serious deterioration of an individual's physical or mental condition.
• Gross failure means a failure that is glaring, obvious or outrageous.
• Callous indifference means an attitude of being unsympathetic, unconcerned or uncaring.

What if....

Eric, an individual, is non-ambulatory and confined to a bed. A physician's order requires him to be repositioned every 30 minutes. Staff fail to reposition him and he develops bed sores after five (5) days.

Is this reportable?

Yes -  Staff appeared to fail to provide Eric with adequate medical care. Staff did not follow a doctor's order to reposition him which appears to have caused him pain and a deterioration of his physical condition - bedsores.

What if…

Other staff see he has developed bedsores but refuse to attend to them because they feel this is a nursing duty and they are tired of doing nurse Evelyn's job. After a month, Eric's bedsores become very deep and cause septicemia (a serious blood infection). Eric is admitted to the hospital in critical condition but survives.

Might this be egregious neglect?

Yes - Staff knew Eric had bedsores and required care, but they refused to attend to him as needed, despite the obvious risk. This could be a gross failure and/or a callous indifference to his medical needs. This resulted in a serious deterioration of Eric's physical condition.

If a case is determined egregious neglect, then the staff's names will be referred to the IDPH Health Care Worker Registry.

Obstructing an Investigation

Per Rule 50, Section 50.50(f), no person shall interfere with or obstruct an OIG interview or investigation which violates Section 1-17(i)(2) of the Human Services Act.

The Human Services Act states that failure to cooperate with an investigation includes, but is not limited to:

• creating and transmitting a false report to the OIG hotline.
• providing false information to an OIG Investigator during an investigation.
• colluding with other employees to cover up evidence
• colluding with other employees to provide false information to an OIG investigator
• destroying evidence or withholding evidence
• otherwise obstructing an Office of the Inspector General investigation.

Material Obstruction of an Investigation

Per the Human Services Act, Material Obstruction of an Investigation is a HCWR reportable finding. It is not incorporated into Rule 50 yet, but it is in force.

Material Obstruction of an Investigation is "[t]he purposeful interference with an investigation of physical abuse, sexual abuse, mental abuse, neglect, or financial exploitation" which includes:

• "withholding or altering of documentation or recorded evidence";
• "influencing, threatening, or impeding witness testimony"; and
• "presenting untruthful information during an interview."

"Presenting untruthful information" is "making a false statement, material to an investigation of physical abuse, sexual abuse, mental abuse, neglect or financial exploitation, knowing the statement is false."

Obstruction of an Investigation is considered material when it could significantly alter an investigator's ability to gather all relevant facts.

If an employee, following a criminal investigation of physical abuse, sexual abuse, mental abuse, neglect, or financial exploitation, is convicted of an offense that is factually predicated on the employee presenting untruthful information during the investigation, that constitutes material obstruction of an investigation.

An employee shall not be placed on the Health Care Worker Registry for presenting untruthful information during an interview conducted by the Office of the Inspector General, unless, prior to the interview, the employee was provided with any previous signed statements he or she made during the investigation.

Examples of Material Obstruction

• Accused staff pleaded guilty to one count of Obstructing Justice in connection to their actions with respect to the physical abuse.
• A witness to the physical abuse falsified an Incident Report stating the Individual's injuries were from self-injurious behavior (SIB), but later admits the Individual had not engaged in SIB.

What is the IDPH Health Care Worker Registry?

The Illinois Department of Public Health maintains the Health Care Worker Registry (HCWR). If someone's name is placed on the HCWR with a substantiated finding of physical abuse, sexual abuse, financial exploitation, egregious neglect, or material obstruction of an investigation against the employee, they cannot work in the healthcare field in Illinois.

OIG will first notify the person of their right to file an appeal of the placement of their name on the HCWR. This is called a 50.90 appeal - named after the section in Rule 50 giving the description of this appeal.

This appeal is about the referral of their name and not the finding of the Investigation. OIG will not refer the name until all pending legal and administrative actions are resolved (grievances, other appeals, etc.) Health Care Worker Registry

Once on the HCWR, the person may appeal to have their name removed by submitting a 50.100 petition. A 50.100 petition can be filed once every twelve (12) months. OIG conducts an investigation to determine the petitioner has provided accurate information in their petition.

The administrative law judge then makes a recommendation on the petition to the DHS Secretary, who ultimately makes the final decision on the petition.

License Referral

The Illinois Department of Financial and Professional Regulation (IDFPR) also investigates allegations against licensed professionals, like doctors and nurses. OIG may report allegation to IDFPR and may be provided OIG's final investigative report.

Health Insurance Portability and Accountability Act (HIPAA)

As an investigative entity, OIG has specific exemptions from the law and employees, agencies and facilities are not in violation of HIPAA when giving OIG information during an investigation.

Initial Incident Response

As detailed in Section 50.30(f) of Rule 50, the agency/facility must do the following in response to any allegation of abuse/neglect:

• Ensure the health and safety of everyone involved - individuals and staff. This includes ordering medical examinations of the individuals.
• Remove accused staff from working with any individuals if there is credible evidence to support the allegation.
• Allow employees trained in OIG 50.30(f) initial incident response to:
  • Secure the scene and keep unauthorized people out.
  • Photograph the scene and any injuries.
  • Keep relevant documents and evidence safe and secure.
  • Identify and separate witnesses and collect witness statements.

OIG Case Findings

OIG must prove its cases by a preponderance of the evidence standards, which means there is enough evidence to show that it is more likely than not that the abuse or neglect occurred.

So, if over 50% of the weighted evidence indicates abuse or neglect occurred, then OIG substantiates the case.

There are three possible findings in an OIG investigation:

• Substantiated - there is a preponderance of the evidence to verify the substance of the investigation.
• Unsubstantiated - this is credible evidence, but less than a preponderance of the evidence to verify the substance of the allegation.
• Unfounded - there is no credible evidence to verify the substance of the allegation.

Recommendations

OIG investigation may find other issues or concerns related to abuse/neglect, like training, staffing, or policy issues. OIG may cite these in the case report as recommendations to the agency or facility.

The agency/facility detail in writing on a Written Response how they will correct the issue noted in the recommendation which might result in a new policy or new staff training.

Notifications

When an investigation is completed, OIG will notify the following people of the finding and notify them of the write to request clarification or reconsideration of the finding:

• Agency/facility authorized representative
• Complainant, if not a required reporter
• Victim or guardian
• Accused employee

The right to request clarification or reconsideration is limited by law to the facility/agency, victim/guardian and accused employee.

Clarification and Reconsiderations Requests

Clarification requests only ask OIG to explain or clarify the investigation or finding.

Reconsiderations requests challenge the findings and/or recommendations, and ask OIG to evaluate the evidence again.

Wrap Up

• Physical abuse, sexual abuse, mental abuse, financial exploitation and neglect involve an individual and a staff, while on or off site.
• Required reporters are required to report all allegations and even suspicions of abuse/neglect to OIG within four (4) of discovery.
• Deaths without any allegation must be reported within 24-hours.
• Screening of allegations is strictly prohibited.
• Failure to report an allegation may result in discipline and can be considered a crime.
• Staff must cooperate with OIG investigations, including answering all questions honestly and fully.
• Accused staff will be notified of the findings by letter.
• OIG Hotline - 800-368-1463 The hotline is available 24 hours a day, 7 days a week, 365 days a year. 

Thank you for completing this training session on OIG's Rule 50. If you have any questions about this training or any other OIG training, please contact us by email:

DHS.OIG.Training@Illinois.gov

You can also contact the respective OIG bureau over your area:

South Bureau - (618) 202-6721

Central Bureau - (217) 786-6865

North Bureau - (708) 338-7191

Metro Bureau - (708) 338-7192

Cook Bureau - (708) 338-7193

Hotline and Intake - (800) 368-1463

Compliance and Evaluation - (217) 786-0165

Administration - (217) 786-6040 or (708) 338-7408