Section 133.47 - Abuse and Neglect Issues(a) Reporting. Incidents of abuse, neglect, exploitation, or illegal, unethical or unprofessional conduct as those terms are defined in subsections (b) and (c) of this section shall be reported to the Texas Health and Human Services Commission (HHSC) as provided in subsections (b) and (c)(3) of this section.(b) Abuse or neglect of a child, and abuse, neglect, or exploitation of an elderly or disabled person. The following definitions apply only to this subsection. (1) Abuse or neglect of a child, as defined in § 1.204(a) and (b) of this title (relating to Abuse, Neglect, or Exploitation Defined).(2) Abuse, neglect, or exploitation of an elderly or disabled person, as defined in §1.204(a) - (c) of this title.(c) Abuse and neglect of individuals with mental illness, and illegal, unethical, and unprofessional conduct. The requirements of this subsection are in addition to the requirements of subsection (b) of this section. (1) Definitions. The following definitions are in accordance with Texas Health and Safety Code (HSC) §161.131 and apply only to this subsection.(A) Abuse-- (i) Abuse (as the term is defined in United States Code Title 42 (42 USC) Chapter 114 (relating to Protection and Advocacy for Individuals with Mental Illness) is any act or failure to act by an employee of a facility rendering care or treatment which was performed, or which was failed to be performed, knowingly, recklessly, or intentionally, and which caused, or may have caused, injury or death to an individual with mental illness, and includes acts such as:(I) the rape or sexual assault of an individual with mental illness;(II) the striking of an individual with mental illness;(III) the use of excessive force when placing an individual with mental illness in bodily restraints; and(IV) the use of bodily or chemical restraints on an individual with mental illness which is not in compliance with federal and state laws and regulations.(ii) In accordance with HSC §161.132(j), abuse also includes coercive or restrictive actions that are illegal or not justified by the patient's condition and that are in response to the patient's request for discharge or refusal of medication, therapy or treatment.(B) Illegal conduct--Illegal conduct (as the term is defined in HSC §161.131(4)) is conduct prohibited by law.(C) Neglect--Neglect (as the term is defined in 42 USC § 10801 et seq.) is a negligent act or omission by any individual responsible for providing services in a facility rendering care or treatment which caused or may have caused injury or death to an individual with mental illness or which placed an individual with mental illness at risk of injury or death, and includes an act or omission such as the failure to establish or carry out an appropriate individual program plan or treatment plan for an individual with mental illness, the failure to provide adequate nutrition, clothing, or health care to an individual with mental illness, or the failure to provide a safe environment for an individual with mental illness, including the failure to maintain adequate numbers of appropriately trained staff.(D) Unethical conduct--Unethical conduct (as the term is defined in HSC §161.131(11)) is conduct prohibited by the ethical standards adopted by state or national professional organizations for their respective professions or by rules established by the state licensing agency for the respective profession.(E) Unprofessional conduct--Unprofessional conduct (as the term is defined in HSC §161.131(12)) is conduct prohibited under rules adopted by the state licensing agency for the respective profession.(2) Posting requirements. A hospital shall prominently and conspicuously post for display in a public area that is readily visible to patients, residents, volunteers, employees, and visitors a statement of the duty to report abuse and neglect, or illegal, unethical, or unprofessional conduct in accordance with HSC §161.132(e). The statement shall be in English and in a second language appropriate to the demographic makeup of the community served and contain the current toll-free telephone number for submitting a complaint to HHSC as specified on the HHSC website.(3) Reporting responsibility.(A) Reporting abuse and neglect. A person, including an employee, volunteer, or other person associated with the hospital who reasonably believes or who knows of information that would reasonably cause a person to believe that the physical or mental health or welfare of a patient of the hospital who is receiving mental health or chemical dependency services has been, is, or will be adversely affected by abuse or neglect (as those terms are defined in this subsection) by any person shall as soon as possible report the information supporting the belief to HHSC or to the appropriate state health care regulatory agency in accordance with HSC §161.132(a).(B) Reporting illegal, unprofessional, or unethical conduct. An employee of or other person associated with a hospital, including a health care professional, who reasonably believes or who knows of information that would reasonably cause a person to believe that the hospital or an employee or health care professional associated with the hospital, has, is, or will be engaged in conduct that is or might be illegal, unprofessional, or unethical and that relates to the operation of the hospital or mental health or chemical dependency services provided in the hospital shall as soon as possible report the information supporting the belief to HHSC or to the appropriate state health care regulatory agency in accordance with HSC §161.132(b).(4) Training requirements. A hospital that provides comprehensive medical rehabilitation, mental health, or substance use services shall annually provide as a condition of continued licensure a minimum of eight hours of in-service training designed to assist employees and health care professionals associated with the hospital in identifying patient abuse or neglect and illegal, unprofessional, or unethical conduct by or in the hospital and establish a means for monitoring compliance with the requirement.(d) Investigations. A complaint under this subsection will be investigated or referred by HHSC as follows. (1) Allegations under subsection (b) of this section will be investigated in accordance with § 1.205 of this title (relating to Reports and Investigations) and § 1.206 of this title (relating to Completion of Investigation).(2) Allegations under subsection (c) of this section will be investigated in accordance with §133.103 of this chapter (relating to Complaint Investigations). Allegations concerning a health care professional's failure to report abuse and neglect or illegal, unprofessional, or unethical conduct will not be investigated by HHSC but will be referred to the individual's licensing board for appropriate disciplinary action.(3) Allegations under both subsections (b) and (c) will be investigated in accordance with § 1.205 and § 1.206 of this title except as noted in paragraph (2) of this subsection concerning a health care professional's failure to report.(e) Submission of complaints. A complaint made under this section may be submitted in writing or verbally to HHSC.(f) Notification. (1) For complaints under subsection (b) of this section, HHSC shall provide notification according to the following. (A) HHSC shall notify the reporter, if known, in writing of the outcome of the completed investigation.(B) HHSC shall notify the alleged victim, and the alleged victim's parent or guardian if a minor, in writing of the outcome of the completed investigation.(2) For complaints under subsection (c) of this section, HHSC informs, in writing, the complainant who identifies themselves by name and address of the following: (A) the receipt of the complaint;(B) if the complainant's allegations are potential violations of this chapter warranting an investigation;(C) whether the complaint will be investigated by HHSC;(D) whether and to whom the complaint will be referred; and(E) the findings of the complaint investigation.(g) HHSC reporting and referral. (1) Reporting health care professional to licensing board. (A) In cases of abuse, neglect, or exploitation, as those terms are defined in subsection (b) of this section, by a licensed, certified, or registered health care professional, HHSC may forward a copy of the completed investigative report to the state agency that licenses, certifies, or registers the health care professional. Any information which might reveal the identity of the reporter or any other patients of the hospital must be blacked out or deidentified.(B) A health care professional who fails to report abuse and neglect or illegal, unprofessional, or unethical conduct as required by subsection (c)(3) of this section may be referred by HHSC to the individual's licensing board for appropriate disciplinary action.(2) Sexual exploitation reporting requirements. In addition to the reporting requirements described in subsection (c)(3) of this section, a mental health services provider must report suspected sexual exploitation in accordance with Texas Civil Practice and Remedies Code § 81.006.(3) Referral follow-up. HHSC shall request a report from each referral agency of the action taken by the agency six months after the referral.(4) Referral of complaints. A complaint containing allegations which are not a violation of HSC Chapter 241 or this chapter will not be investigated by HHSC but shall be referred to law enforcement agencies or other agencies, as appropriate.25 Tex. Admin. Code § 133.47
The provisions of this §133.47 adopted to be effective June 21, 2007, 32 TexReg 3587; Amended by Texas Register, Volume 49, Number 46, November 15, 2024, TexReg 9231, eff. 11/21/2024