Chapter 1 – Anti Abuse

11-1.1 INTRODUCTION

1. Purpose. This policy establishes roles and responsibilities to prevent abuse of any kind by Indian Health Service (IHS) Staff (defined below) against fellow Staff, patients, and visitors. It outlines Staff responsibilities and addresses reporting procedures and requirements.
2. Scope. This policy applies to all Staff while on duty, on official travel, or in an IHS Facility. The policy covers all abuse, or reasonable suspicion of abuse, committed by any Staff against another Staff member, a patient, or a visitor while on duty, on official travel, or in an IHS Facility. This policy also designates all Staff as mandatory reporters of suspected abuse.
3. Authorities and References.
   1. Standards of Ethical Conduct for Employees of the Executive Branch, 5 C.F.R. § 2635; Exit Disclaimer: You Are Leaving www.ihs.gov 
   2. Department of Health and Human Services (HHS) Residual Standards of Conduct, 45 C.F.R. Part 73; Exit Disclaimer: You Are Leaving www.ihs.gov 
   3. Adverse Actions, 5 C.F.R. Part 752; Exit Disclaimer: You Are Leaving www.ihs.gov 
   4. Indian Health Care Improvement Act, 25 U.S.C. § 1661;
   5. No FEAR Act; Exit Disclaimer: You Are Leaving www.ihs.gov 
   6. Prohibited Personnel Actions, 5 U.S.C. § 2302; Exit Disclaimer: You Are Leaving www.ihs.gov 
   7. HHS Instruction 752, Discipline and Adverse Actions (March 20, 2009); and 5 C.F.R. 752 (Adverse Actions); Exit Disclaimer: You Are Leaving www.ihs.gov 
   8. Indian Health Manual (IHM), Part 3, Chapter 23, Ethical and Professional Conduct of Health Care Providers;
   9. IHM, Part 7, Chapter 5, Administrative Grievance System.
4. Policy. It is the IHS policy to provide a safe environment for Staff, patients, and visitors. The Agency has no tolerance for any type of abuse. Staff must not engage in abuse of any kind. All Staff are required to report any suspected abuse involving Staff, patients, and visitors.

   The IHS will not take any administrative or other adverse action against a Staff member who, in good faith and in accordance with applicable laws and policy, reports suspicion of abuse by another Staff member. Any Staff member who has authority to take, direct others to take, recommend, or approve any personnel action, shall not, with respect to such authority, take or threaten to take any action against any Staff member as a reprisal for reporting suspected abuse.

5. Definitions.
1. Abuse - For purposes of this policy, the IHS defines “abuse” as a behavior whereby a Staff member intentionally mistreats and causes harm to another person. This can include multiple patterns of verbal, visual, and physical behavior or a single incident, depending on the nature of the behavior and the harm caused through encounter, experience, observed, or suspected.
2. Corrective Action - Action taken to promote the efficiency of the service and motivate employees to conform to acceptable behavioral standards and prevent prohibited and/or unsafe activities.
3. IHS Facility - For the purpose of this policy, IHS Facility includes Headquarters (HQ), Area Offices, Service Units, Clinics, and any other facility in which the IHS operates. An IHS Facility includes the buildings themselves, as well as the surrounding grounds on which the building is located (e.g., parking lots).
4. Office of Inspector General (OIG) - The OIG is an agency of the HHS whose mission is to protect the health and welfare of all HHS program beneficiaries through a multifaceted approach that promotes efficiency and integrity aimed to eliminate fraud, waste, and abuse. Among other things, OIG investigates reports of abuse by Staff. The OIG provides recommendations for program improvements to the IHS community, including pursuing law enforcement action against those who violate the law or the IHS program guidelines.
5. Senior Organizational Leader - Senior IHS organizational leaders include the following: Deputy Director for Management Operations, Deputy Director for Field Operations, Deputy Director for Intergovernmental Affairs, Deputy Director for Quality Health Care, Chief of Staff, and Chief Medical Officer.
6. Staff - Staff includes all Civil Service employees, and as agreed to, contractors, students, residents, and volunteers at an IHS Facility, as well as other civilian employees working under an Intergovernmental Personnel Act agreement. United States Public Health Service (USPHS) Commissioned Corps Officers (including those on detail to the IHS from other federal agencies) will be considered Staff for purposes of this policy.
7. Visitor - A visitor includes friends and family members, guardians, caregivers of patients, and Staff, as well as vendors and stakeholders who are invited into an IHS Facility.

11-1.2 RESPONSIBILITIES

1. Director and Deputy Director, IHS. Ensures that all senior organizational leaders read and understand this policy and communicate its contents to subordinate personnel. Instills a positive attitude toward identifying, reporting, and preventing abuse throughout all echelons and units of the Agency. Holds all senior organizational leaders accountable for taking appropriate investigative and corrective action when allegations of abuse arise, as well as collaborating and consulting with the HHS OIG and the IHS Office of Human Resources (OHR) when a criminal investigation is ongoing and administrative investigation and/or action is being considered apart from the criminal investigation.
2. Senior Organizational Leaders. Ensures that all subordinate supervisors read and understand this policy and communicate its contents to subordinate Staff. On behalf of the Director, IHS instills a positive attitude toward identifying, reporting, and preventing abuse throughout all echelons and units of the Agency. Holds all subordinate supervisors at all levels accountable for taking appropriate investigative and corrective action when allegations of abuse arise. Requires all subordinate supervisors to collaborate and consult with the HHS OIG and IHS OHR when a criminal investigation is ongoing and administrative investigation and/or action is being considered apart from the criminal investigation.
3. Office of Human Resources Director and Servicing Regional Human Resource Directors. The OHR Director and servicing Regional Human Resource (HR) Directors are responsible for:
   1. coordinating with HHS OIG on allegations reported and when a criminal investigation is ongoing and administrative investigation and/or action is being considered apart from the criminal investigation;
   2. advising and assisting management officials with necessary actions for Staff accused of any type of abuse, when indicated. Actions include any interim steps necessary to protect the accuser and/or the accused, during the investigatory procedures, and corrective action; and
   3. guiding Staff in reporting suspected abuse.
4. Area Directors and HQ Office Directors. The AD and HQ Directors are responsible for:
   1. communicating this policy to all Staff and ensuring that they read and understand the policy;
   2. completing an annual review of Staff compliance with this policy;
   3. reporting allegations or complaints regarding abusive conduct to the HHS OIG, the OHR Director or servicing Regional HR Director, and Senior Organizational Leaders, as appropriate;
   4. ensuring IHS Area/HQ Offices have procedures in place to address reports concerning abuse;
   5. holding subordinate supervisors at all levels accountable for taking appropriate investigative and corrective action when allegations of abuse arise. Requiring all subordinate supervisors to collaborate and consult with the HHS OIG and the IHS OHR when a criminal investigation is ongoing and administrative investigation and/or action is being considered apart from the criminal investigation.
5. Chief Executive Officer (CEO). The CEO is responsible for:
   1. Establishing local procedures to execute this policy, to include:
      1. creating guidelines for reporting allegations or complaints of suspected abuse and options for reporting abuse as outlined in this policy; and
      2. posting information for Staff, patients, and visitors, which includes reporting instructions and the IHS Hotline, HHS OIG Hotline, local law enforcement and child protective services contact information for the required reporting of concerns of abuse.
   2. Ensuring that all reasonable suspicions of abuse by Staff are reported in accordance with this policy and local procedures.
   3. Holding subordinate supervisors at all levels accountable for taking appropriate investigative and corrective action when allegations of abuse arise. Requiring all subordinate supervisors to collaborate and consult with the HHS OIG and the IHS OHR or servicing Regional HR office when a criminal investigation is ongoing and administrative investigation and/or action is being considered apart from the criminal investigation.
6. Supervisors. All supervisors are responsible for:
   1. ensuring that all subordinate Staff read, understand, and follow this policy and any applicable local procedures that implement this policy;
   2. emphasizing the critical importance of reporting any abuse that Staff encounter, experience, observe, or suspect;
   3. collaborating and consulting with the HHS OIG when a criminal investigation is ongoing and administrative investigation is being considered apart from the criminal investigation; and
   4. taking immediate action needed to address any urgent matters including placing Staff on administrative leave or investigate any observed or alleged abuse or abuse-related incident and collaborating and consulting with the HHS OIG and the IHS OHR or servicing Regional HR office when a criminal investigation is ongoing and administrative investigation and/or action is being considered apart from the criminal investigation.
7. All Staff. All Staff are responsible for:
   1. reading and understanding this policy;
   2. understanding what behavior constitutes abuse and refraining from all forms of abusive behavior;
   3. following this policy and any applicable local procedures that implement this policy; and
   4. immediately (and in all cases within 24 hours of the incident) reporting any abuse they experience, observe, suspect, or learn about to either their immediate supervisor, second line supervisor, to the IHS Hotline at 301 443-0658, or to the OIG Hotline at 1-800-447-8477 immediately (and in all cases within 24 hours of the incident).

11-1.3 EMPLOYEE RIGHTS

1. Confidentiality. All allegations of abuse and related information are kept on a confidential basis to the greatest extent possible and permitted by Federal law. The identity of the Staff reporting the alleged violations, as well as the Staff member under investigation, will be kept confidential, except as necessary to conduct an appropriate investigation into the alleged violation or when otherwise required by law.
2. Reprisals Prohibited. Any attempt by any Staff, including the Staff member under investigation, to restrain, interfere, coerce, or otherwise take reprisal action against another Staff member who has reported the alleged violations is prohibited. Such actions may result in corrective action.
3. C. Grievance Process. Reports and actions pursuant to this policy do not replace or substitute the different forums that may be utilized, including but not limited to the following processes: the negotiated grievance procedure, Agency grievance procedure (IHM, Part 7, Chapter 5, Administrative Grievance System), Merit Systems Protection Board, Equal Employment Opportunity, or any other statutory processes.