SUBSTANCE ABUSE INDUSTRY NEWS #14
TREATMENT CENTER LAW: INCIDENT REPORTING
In most states, substance abuse and behavioral health facilities (“treatment centers”) have organizational-level incident reporting obligations independent from those of its individual medical and mental health personnel. Similar to the mandatory reporting requirements imposed upon these and other types of professionals, treatment centers (as with most other healthcare facilities) are required to report suspected abuse or neglect of children and vulnerable adults, instances of domestic violence or sexual assault, among other statutorily-defined “incidents” or “events.”
In Florida, treatment centers are also subject to an exceptionally broad definition of events that constitute a reportable incident. Moreover, each organization is responsible for implementing procedures to ensure that all staff understands his or her own affirmative duty to report such incidents.
Sources of Legal Authority
Chapter 397 of the Florida Statutes, labeled “Substance Abuse Services,” provides for the rights and obligations of substance use disorder patients and treatment centers, respectively. Accordingly, this section establishes the foundational incident reporting guidelines by which treatment centers must adhere. Under § 397.4103(2)(f), Florida Statutes (2020), treatment centers are responsible for developing a written plan which addresses “incident reporting policies and procedures” and includes provisions on corrective action, documentation, and timeliness.
For the most part, though, the statute serves as an enabling act granting the Department of Children and Families (DCF) authority to promulgate rules and regulations related to incident reporting requirements of treatment centers.
The DCF’s Substance Abuse Services Office publishes rules related to treatment centers in Chapter 65D-30 of the Florida Administrative Code. As for incident reporting directives, Rule 65D-30.004, "Common Licensing Standards," is instructive. It provides detailed incident reporting procedures, including defining the type of incidents subject to reporting, the entities or agencies to which reports must be submitted, and the timing requirements of the reports.
In addition, licensing institutions such as The Joint Commission often require that accredited institutions adhere to certain standards regarding incident reporting. However, these are generally consistent with those rules established by State agencies such as the DCF.
What is a reportable incident?
Rule 65D-30.004(17) (b) enumerates several events designated as “critical incidents” that are subject to reporting. This list includes reporting when a patient dies either during treatment or shortly after, significant injuries to patients or staff, and patient suicide attempts. Nevertheless, the scope of the term “incident” is not exactly clear under the Rules. Still, if a treatment center staff-member finds him- or herself considering the issue, it is more than likely the incident warrants reporting. The basis of this claim lies in the catchall provision found in 65D-30.004(17) (b)14, which requires that a treatment center report “Any major event not previously identified as a reportable critical incident but has, or is likely to have, a significant impact on individuals receiving services….”
The ambiguity of the catchall provision, along with the vague language in some of the enumerated events (e.g., it is not clear exactly what constitutes a significant injury), is likely meant to encourage self-reporting from treatment centers. Thus, a treatment center's liability in failing to report an arguably reportable incident may depend on whether management effectively institutes and enforces its reporting policy in general.
Timing of reporting
Under the same section of the Rules, treatment centers must report critical incidents within 24 hours of their occurrence. Additionally, when a treatment center learns that a former patient has passed within 30 days of discharge from its program, it must report the death within 24-hours of such knowledge.
Licensed DCF treatment centers and their personnel are statutorily obligated to implement reporting policies and procedures to respond to critical events that occur while rendering services. According to the DCF, incident reporting “enables . . . [it] to collect and analyze information about critical incidents” for the purpose of improving patient outcomes. Although there are limitations to current reporting systems across the healthcare industry, these mechanisms can nevertheless provide valuable insights into how and why patients are harmed at the organizational level. This sort of practice is consistent with the widely-accepted notion that reporting systems are an important influence on improving patient safety. As such, it is critical that substance abuse and behavioral health treatment centers take notice of these principles and the corresponding statutory/regulatory directives.
*DCF requires treatment centers to self-report these incidents through its Incident Reporting and Analysis System (IRAS). IRAS is an online incident reporting tool that enables the DCF to collect and analyze information about critical incidents that occur in all licensed substance abuse providers and contracted mental health treatment providers. As an additional safeguard to the bias inherent in self-reported data, the DCF maintains an online portal through which the public can provide incident information or file a general complaint (Link). Similarly, the Florida Association of Recovery Residences (FARR)—the organization tasked with oversight of sober housing—has its own online incident and grievance reporting tool (Link). We encourage those with complaints to report them to the appropriate agency.
At Romano Law Group, Rainer Boggiano is focused on representing plaintiffs in catastrophic injury matters, including wrongful death, negligence, medical malpractice, and products liability litigation.
Rainer earned his Juris Doctor from the University of Florida Levin College of Law in Gainesville, Florida and his Bachelor of Business Administration in Economics from Florida Atlantic University in Boca Raton, Florida.
While attending law school, Rainer served as a judicial extern at Florida’s Fourth District Court of Appeal and a legal intern for ADT Security Services at its corporate headquarters in Boca Raton. He graduated with multiple Dean’s List honors and was a Pro Bono Award recipient in recognition for completing 150+ hours of community service. Currently, he is assisting with the Pro Bono work on behalf of the Florida Association of Recovery Residences.
Rainer is active in several community organizations, having served as a volunteer for the 15th Judicial Circuit’s Guardian ad Litem Program, a tutor at the Mandel Public Library’s homework center, and a mentor for several local non-profit organizations.
Susan Ramsey is both an attorney and an RN. Ms. Ramsey’s professional experience began as a Registered Nurse in the Intensive Care Unit at Yale New Haven Hospital. While pursuing her Bachelor’s Degree, she was a counselor with the New Haven Rape Crisis Program. During her time with the Program, Ms. Ramsey counseled sexual assault survivors and performed seminars for local police departments, universities, and high schools. During her time working as a registered nurse, Ms. Ramsey decided to attend law school. Ms. Ramsey graduated from CUNY Law School, and has practiced law in several different State and Federal Courts. She is a Florida Heath Care Risk Manager and a member of the Palm Beach County Sober Home Task Force. Susan is Pro Bono Counsel for the Florida Association of Recovery Residences.
Ms. Ramsey actively litigates cases involving catastrophic injuries and wrongful death on behalf of survivors, cases include injuries suffered by victims of professional product liability and medical negligence.