One Day at a TimeCompliance and Ethics in the Aftermath of a Tragedy
Ginger R. Bandeen, LCSW, CHCColumbia Community Mental Health
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Session Outline:
• Overview of critical incident
• Phases of agency response– Agency/Leadership Goals– Compliance Role– Impact on the Compliance Program
• Overall lessons learned
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May 20, 2012
• CCMH employees and managers learn from police that a coworker has been killed while serving clients as a CCMH employee.
• Staff, clients, and the mental health community at large is devastated.
• Police investigation begins; media coverage is intense.
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May 21 - 25, 2012
• OSHA investigation begins, including inspection of the crime scene.
• Staff participate in a de-briefing facilitated by the fire department’s chaplain.
• CCMH receives a search warrant from the police department.
• Ongoing client support continues.4
Impact on Compliance and Ethics
Local Community
Agency Staff and Clients
Leadership Team
Compliance Officer
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June – October, 2012
• Multiple ongoing investigations:– Oregon Occupational Safety and Health
Administration - Fatality Investigation– Oregon Health Authority - Root Cause
Analysis– St. Helens Police Department - Criminal
Investigation– Office of Investigation and Training -
Screening for possible abuse/neglect– Internal investigation by CCMH
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Managing Records Requests
• Identifying all records related to an individual client or staff member.
• Electronic and paper locations, including shred bins.
• Redaction, Bates numbering, and secure storage.
• Document preservation.
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November, 2012 – February, 2013
• Investigation reports and recommendations are released.– CCMH employees are offered access to
public reports.– Media outlets also request and receive
these reports and records.
• February 12, 2013 – Brent Reddpleads ‘Guilty Except for Insanity’.
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Overlapping Phases
1. Crisis response
2. Gathering and preserving documents
3. Analyzing and interpreting data
4. Implementing recommendations
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Crisis Response
Agency/Leadership Goals:• Reporting information and
responding to requests from various entities appropriately.
• Resuming operations to meet client needs, while also meeting staff needs.
• Managing media requests.
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Crisis Response
Compliance Role:• Identify reporting requirements.• Provide support to staff and managers
to protect information that is covered by HIPAA and other privacy laws.
• Raise/address ethical issues regarding the options for staff and client support.
• Encourage clear communication.11
Crisis Response
Impact on the Compliance ProgramRespond to the increased needs:
– Be informed of evolving agency goals/direction.
– Be a visible resource for staff and managers who are struggling, not a forgotten branch.
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Gathering & Preserving Documents
Agency/Leadership Goals:• Transparency and cooperation with
investigating bodies.• Avoiding disruption of business and
harm to clients and staff.• Balance competing needs for
resources.
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Gathering & Preserving Documents
Compliance Role:• Identify the need for outside
resources.– Legal counsel– Administrative support
• Develop processes to ensure complete, protected record sets.
• Know your limits in time and expertise.
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Gathering & Preserving Documents
Impact on the Compliance ProgramRespond to the increased needs:
– Organization systems for massive amounts of documentation
– Identifying effective methods for interviewing staff to gather information
– Facilitating interviews with outside entities
– Managing expectations
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Analyzing and Interpreting Data
Agency/Leadership Goals:• Agency sustainability• Managing overwhelming amounts of
information• Identifying areas for growth, concrete
measures
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Analyzing and Interpreting Data
Compliance Role:• Maximize access to information, with
context and background to make data actionable.
• Identify:– Manageable goals for data analysis– Necessary resources– Timelines for completion
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Analyzing and Interpreting Data
Impact on the Compliance ProgramRespond to the increased needs:
– Identifying gaps in available data and correcting misperceptions.
– Understanding the business operations being studied and how data is impacted by systems.
– Correcting errors that arise as identified.
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Implementing Recommendations
Agency/Leadership Goals:• Ensure rapid implementation of
recommendations.• Prevent unnecessary interruptions of
service to clients.• Staff retention.
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Implementing Recommendations
Compliance Role:• Monitor for potential compliance
issues or ethical challenges.• Identify methods for ongoing
monitoring of new systems.• Assist with managing increased
workloads and stress.
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Implementing Recommendations
Impact on the Compliance ProgramRespond to the increased needs:
– Identify areas where strain has the potential to impact ongoing compliance and organizational ethics.
– Provide training and support to staff to make Compliance visible and helpful.
– Assist with de-briefing staff as needed.
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Overall Lessons
• There is no such thing as too much support for staff and clients.– Offering support demonstrates agency
commitment.• Rarely is there such a thing as too
much information.– Don’t assume people have the right
information or feel comfortable asking for clarification.
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Overall Lessons
• Health care providers and lawyers have very different training.– “Common sense” ideas are not
consistent across these fields.• Managing expectations is especially
challenging with rare events. – Staff and managers do not know what to
expect from themselves or the system.
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Overall Lessons
• If staff express an interest in helping, consider finding a way for them to get involved in the process.
• Consider suggestions and alternatives carefully.
• Give people a safe way to express their thoughts & feelings.
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Increasing Preparedness
• Policies and Procedures can provide guidance regarding:– Requests for information from media
outlets, commenting on online news articles
– The use of social media by staff – Document retention– Reporting requirements and
communication structure in emergencies
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Increasing Preparedness
• Training and Education for managers and staff:– Relationships with media and legal
counsel– Dealing with challenging interviews
with investigators– Sharing information in emergency
situations– Avenues for expressing concerns
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Increasing Preparedness
• Self-care can’t be the last thing you think about.– Leaders need to model good self-care.– Remember family members of staff.– Everyone experiences trauma uniquely,
and heals differently.
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Additional Information• Media Coverage:
– http://www.katu.com/news/local/Mental-health-worker-killed-in-St-Helens-152213315.html?tab=video&c=y
– http://www.oregonlive.com/health/index.ssf/2012/05/questions_probes_follow_murder.html
– http://www.oregonlive.com/pacific-northwest-news/index.ssf/2013/02/man_pleads_guilty_but_insane_i.html
– http://www.mentalhealthportland.org/?tag=brent-redd
• OSHA Guidelines for Preventing Workplace Violence for Health Care and Social Service Workers:
– http://www.osha.gov/Publications/osha3148.pdf
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• For more information, please feel free to contact:
Ginger R. Bandeen, LCSW, CHCQuality Improvement Manager/Compliance OfficerColumbia Community Mental HealthP. O. Box 1234, St. Helens, OR 97051(503) 397-5211, [email protected]
Additional Information
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