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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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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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– 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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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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– 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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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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– 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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• 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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• 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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