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U.S. Department of Health and Human Services
Indian Health Manual

Chapter 2 – Protecting Children from Sexual Abuse by Health Care Providers

Title Section
Introduction 11-2.1
    Purpose 11-2.1A
    Scope 11-2.1B
    Background 11-2.1C
    Authorities 11-2.1D
    Policy 11-2.1E
Definitions 11-2.1F
Responsibilities 11-2.2
    Director, and Deputy Director, IHS 11-2.2A
    Senior Organizational Leaders 11-2.2B
    Director, Office of Human Resources and Directors, Servicing Regional Human Resource Offices 11-2.2C
    Deputy Director for Field Operations, IHS 11-2.2D
    Director for the Office of Quality, IHS 11-2.2E
    Director for Office of Management Services, IHS 11-2.2F
    Area Director 11-2.2G
    Chief Executive Officer / Service Unit Director 11-2.2H
    Supervisors 11-2.2I
    Health Care Provider 11-2.2J
    All Staff 11-2.2K
Chaperones 11-2.3
Training Requirements 11-2.4
    All Staff 11-2.4A
    Federal Staff 11-2.4B
    IHS Contractors 11-2.4C
    Students, Residents, and Volunteers 11-2.4D
Tracking Training Completions 11-2.4E
Employee Rights 11-2.5
    Investigation 11-2.5A
    Confidentiality 11-2.5B
    Reprisals Prohibited 11-2.5C
    Grievance Process 11-2.5D

11-2.1 INTRODUCTION
  1. Purpose. This policy provides professional standards and guidance to protect children against sexual abuse by health care providers.
  2. Scope. This policy applies to all Indian Health Service (IHS) staff, including (but not limited to) employees, volunteers, contractors, and trainees. This policy covers child sexual abuse, or reasonable suspicion of child sexual abuse committed at any location by any health care provider working for the IHS. Although this policy is specific to child sexual abuse by a health care provider, note that other IHS policies cover abuse more broadly, and nothing in this policy is intended to limit prevention or reporting of instances of abuse that fall outside the scope of this policy.
  3. Background.   Pediatricians and other health care providers are entrusted with the responsibility to improve the health and well-being of children. The IHS has a zero tolerance policy for misuse of a health care provider’s authority and trust to sexually abuse or exploit children. Children are especially vulnerable to abuse. Every staff member in the IHS has a responsibility to ensure the safety of children in health care settings, abide by appropriate provider-patient boundaries, and to scrupulously follow reporting requirements and investigation procedures as specified in this policy and as required by law. The IHS supports the American Academy of Pediatrics (AAP) position statement on sexual abuse by health care providers: “The American Academy of Pediatrics stands strongly behind the social and moral prohibition against sexual abuse or exploitation of children by health care professionals.”
  4. Authorities and References.
    1. Indian Health Care Improvement Act, 25 U.S.C. § 1665a;
    2. Snyder Act, 25 U.S.C. § 13;
    3. Indian Child Protection and Family Violence Prevention Act, 25 U.S.C. §§ 3201 – 3210; 42 C.F.R. §§ 136.401-418;
    4. Victims of Child Abuse Act, 34 U.S.C. § 20341 (Federal child abuse reporting requirement) and 34 U.S.C. § 20351 (requirement for background checks);
    5. 18 U.S.C. § 1169 (reporting of child abuse in Indian Country);
    6. No FEAR Act, 5 U.S.C. § 2302 (b)(8);
    7. Indian Health Manual, Part 3, Chapter 23, Ethical and Professional Conduct of Health Care Providers; and
    8. Laskey, A., Haney, S., and Northrop, S. Protecting Children From Sexual Abuse by Health Care Professionals in the Health Care Setting. https://doi.org/10.1542/peds.2022-058879 (American Academy of Pediatrics position statement).
  5. Policy.  It is the policy of the IHS that:
    1. Health care providers will never engage in child sexual abuse (as defined in this Chapter), including, but not limited to sexual activity, sexual communication (through the use of technology, in person, or otherwise), or sexual contact with current or former patients under the age of 18;
    2. There is zero tolerance for all forms of sexual abuse or exploitation of patients;
    3. All IHS facilities will post information on the process for IHS staff to report any child sexual abuse. This includes the notification of appropriate child protective services and/or law enforcement, the Department of Health and Human Services (HHS) Office of Inspector General (OIG) Hotline 1-800-HHS-TIPS (1-800-447-8477), HHS OIG hotline website, the IHS Hotline 1-855-SAFE-IHS (1-855-723-3447), and the administration of that facility, except where Federal law requires reporting to additional entities. The IHS facilities will also post information in plain sight for patients, visitors, and others in the IHS facility on reporting any child sexual abuse to the facility staff or administration of the facility or by using the IHS Hotline; and
    4. No administrative or other adverse action will be taken against an IHS staff member who, in good faith and in accordance with applicable laws and policy, reports child sexual abuse or the suspicions of child sexual abuse by a health care provider.

  6. Definitions. 

    1. Chaperone. A medical staff member who has a favorably adjudicated background investigation as required under 25 U.S.C. § 3207 and 34 U.S.C. § 20351, and who attends a medical procedure or exam, as a safeguard and witness, for both the child and the health care provider. A parent, guardian, family member, or friend of the patient may not act as a chaperone. Medical students, medical residents, or any other students are not allowed to serve as chaperones.
    2. Child. A child, for the purposes of this policy, is a person under the age of 18 years old.
    3. Child Sexual Abuse. Child sexual abuse (which includes exploitation and sexually inappropriate behavior) is engaging a child in sexual activities, including, but not limited to genital, anal, or oral contact. Child sexual abuse includes non-contact abuse such as exposing the child to exhibitionism, voyeurism, or sexually explicit material; using the child in pornography; and pandering the child for sex by others. It also includes the employment, use, persuasion, inducement, enticement, coercion, or assistance of any person in order to engage in any sexually explicit conduct or simulation of such conduct for the purpose of producing a visual depiction of such conduct. It also includes rape, statutory rape, molestation, commercial sex with, or other form of sexual exploitation of children; or incest with children. The sexual activities may include all forms of fondling, oral-genital, genital, or anal contact by or to children.
    4. Family Member. A family member, for the purpose of this policy, includes parents, legal guardians, grandparents, siblings-in-law, or someone who has an expectation to provide care for a child, who may lawfully exercise parental rights with respect to a child.
    5. Grooming. Grooming is befriending and establishing an emotional connection with a child, the child’s family member, or someone else close to the child with the goal of gaining the trust of adults and lowering the child’s inhibitions.
    6. Health Care Provider. Anyone who provides physical or behavioral health care or treatment to patients, e.g., including, but not limited to physicians, nurses, dentists, podiatrists, optometrists, physician assistants, pharmacists, psychologists, counselors, radiologists, medical technicians, all medical support staff and anyone authorized to diagnose or treat health conditions.
    7. IHS Safety and Tracking Response System. An electronic incident reporting system used by IHS facilities for collecting and maintaining: occupational injury and illness data; visitor injury data; patient safety error and adverse event data; reporting physical security events, property damage, and hazardous conditions; conducting trend analysis; and producing reports.
    8. Mandated Reporting. Mandated or mandatory reporting refers to the laws which mandate certain agencies and persons in specific professions (e.g., teachers, social workers, health care providers) report actual or suspected child abuse (e.g., physical, sexual, neglect, emotional, and psychological abuse) to child protection or criminal justice authorities. For the purposes of this policy, all IHS staff are mandatory reporters.
    9. Office of Inspector General. The Office of Inspector General (OIG) is an agency of 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.
    10. Senior Organizational Leaders. Senior 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.
    11. Staff. Staff includes all civil service employees at an IHS facility, as well as other civilian employees working under an Intergovernmental Personnel Act agreement or other agreement. United States Public Health Service, Commissioned Corps Officers (including those on detail to the IHS from other Federal agencies), contractors, students, residents, and volunteers will be considered staff for purposes of this policy.
    12. Child Protective Services. Child Protective Services (CPS) is a governmental agency responsible for addressing issues of child abuse and neglect. The CPS, or other equivalent agencies, typically maintain records of child abuse and neglect reports to aid in the investigation, treatment, and prevention of child abuse and neglect.
11-2.2 RESPONSIBILITIES
  1. Director and Deputy Director, IHS. Each 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 child sexual abuse throughout all echelons and units of the Agency. Holds all senior organizational leaders accountable for taking appropriate corrective action when allegations of child sexual abuse are reported, ensures that the IHS operations comply with the applicable laws, regulations, and standards.
  2. Senior Organizational Leaders. They ensure that all subordinate supervisors read and understand this policy and communicate its contents to their subordinate staff. On behalf of the Director, IHS, instills a positive attitude toward identifying, reporting, and preventing child sexual abuse throughout all echelons and units of the Agency. Holds all subordinate supervisors at all levels accountable for taking appropriate corrective action when allegations of child sexual abuse are reported. Requires all subordinate supervisors to collaborate and consult with the HHS OIG and the IHS Office of Human Resources (OHR) when allegations of child sexual abuse are reported.

  3. Director, OHR, and Directors, Servicing Regional Human Resource Offices. Responsible for:

    1. Coordinating with HHS OIG on reported child sexual abuse allegations;
    2. Guiding IHS staff in reporting to HHS OIG and the IHS Hotline all instances of suspected child sexual abuse;
    3. Assisting management officials in the development of official notices and decision letters regarding the official corrective action taken against health care providers accused of child sexual abuse, when indicated;
    4. Developing and overseeing mechanisms to prevent the transfer or hire of health care providers within the Indian Health System that have substantiated complaints of, are under investigation for, or are suspected of (past or current) child sexual abuse;
    5. Compiling and reporting completion status of staff (Agency-wide) training required under this policy for Indian Health Manual (IHM) Part 11 Chapter 2 to the Director, IHS annually no later than October 7; and
    6. Working with supervisors to address non-compliance of training requirements detailed in this policy.
  4. Deputy Director for Field Operations, IHS. Responsible for:
    1. Serving as a liaison between Area Directors and Office of the General Counsel (OGC), OHR, and the Office of the Director, if required;
    2. Alerting IHS senior leadership of any reports of child sexual abuse by health care providers received from Area Directors;
    3. Ensuring mandatory reporting requirements of actual or suspected sexual abuse or exploitation of a child by a health care provider are established Agency-wide;
    4. Ensuring compliance with mandatory Protecting Children from Sexual Abuse by Health Care Providers training for all IHS staff working in the IHS Areas; and
    5. Reporting IHS Area-wide annual training compliance annually to Director, OHR, IHS by October 5.

  5. Director for Office of Quality, IHS. Responsible for reviewing the Agency’s responses to reports of actual or suspected sexual abuse or exploitation of a child by a health care provider through the IHS Hotline and the IHS incident reporting systems on a quarterly basis in order to:

    1. Assess the effectiveness of actions taken to safeguard patients;
    2. Review compliance with agency reporting practices described in this chapter;
    3. Report any inconsistencies in the compliance and reporting of child sexual abuse by a health care provider to senior organizational leaders; and
    4. Provide recommendations for Agency-wide changes to senior organizational leaders to improve the IHS’s response to reports of child sexual abuse.
  6. Director for Office of Management Services, IHS. Responsible for ensuring each service contract includes the requirement for completing training on this policy content before contracting staff start working at the IHS.

  7. Area Directors. Responsible for ensuring that all subordinate supervisors read and understand this policy and communicate its contents to their subordinate staff. On behalf of the Director, IHS, instills a positive attitude toward identifying, reporting, and preventing child sexual abuse throughout all echelons and units of the Area. Holds all subordinate supervisors at all levels accountable for taking appropriate corrective action when allegations of child sexual abuse are reported. Requires all subordinate supervisors to collaborate and consult with HHS, OIG, IHS, and OHR when allegations of child sexual abuse are reported. Area Directors are responsible for:

    1. Completing an annual review for compliance with this policy for all IHS facilities within their respective region;
    2. Reporting any violations of this policy by IHS staff to the Deputy Director for Field Operations (DDFO), IHS, and other Senior Organizational Leaders, as appropriate;
    3. Reporting the temporary or permanent transfer of staff to another health care facility, prior to the transfer, if the staff member’s transfer is related to a possible violation of this policy to the DDFO, IHS, and other Senior Organizational Leaders, as appropriate;
    4. Ensuring the IHS Area Governing Boards have procedures in place to address reports concerning child sexual abuse by health care providers;
    5. With consultation by OHR or Servicing Regional Human Resource Offices, ensuring all reports of retaliation against reporters of abuse are investigated and resolved;
    6. Reporting Area-wide annual training compliance annually to Deputy Director for Field Operations, IHS by October 3 of respective year;
    7. Ensuring any incidents and reasonable suspicion of child sexual abuse by IHS health care providers is reported to the regional and headquarters (HQ) human resources offices, appropriate CPS, and/or law enforcement, HHS OIG, the IHS Hotline, and appropriate licensing boards.

  8. Chief Executive Officer / Service Unit Director. Ensures that all subordinate supervisors read and understand this policy and communicate its contents to their subordinate staff. On behalf of the Director, IHS, and the Area Director, instills a positive attitude toward identifying, reporting, and preventing child sexual abuse throughout all echelons and units of the Agency. Holds all subordinate supervisors at all levels accountable for taking appropriate corrective action when allegations of child sexual abuse are reported. Requires all subordinate supervisors to collaborate and consult with the HHS OIG, IHS, and OHR when allegations of child sexual abuse are reported. The Chief Executive Officer (CEO) is responsible for:

    1. Establishing procedures to execute and enforce this policy, including: creating guidelines for mandatory reporting to the appropriate child protective services and/or law enforcement, HHS OIG Hotline 1-800-HHS-TIPS (1-800-447-8477), the IHS Hotline 1-855-SAFE-IHS (1-855-723-3447), the IHS Area Director, IHS Area Governing Board, and IHS HQ, OHR;
    2. Posting information for staff, patients, family members, caregivers, and others, which includes the appropriate child protective services and/or law enforcement, HHS OIG Hotline 1-800-HHS-TIPS (1-800-447-8477), the IHS Hotline 1-855-SAFE-IHS (1-855-723-3447) for required reporting of concerns of child sexual abuse by an IHS health care provider;
    3. Consulting with the OGC to identify the appropriate child protective and law enforcement authorities for each respective facility and the legal time frames for reporting.
    4. Ensuring any incidents and reasonable suspicions of child sexual abuse by an IHS health care provider is reported to the regional and HQ human resource offices, appropriate child protective services and/or law enforcement, HHS, OIG Hotline 1-800-HHS-TIPS (1-800-447-8477), the IHS Hotline 1-855-SAFE-IHS (1-855-723-3447), and appropriate licensing boards;
    5. Cooperating with all law enforcement and administrative investigations of child sexual abuse or exploitation by IHS staff;
    6. In consultation with OHR or Servicing Regional Human Resource Offices, to the extent possible, maintaining the confidentiality of the reporter and the suspected health care provider; ensuring reporters of abuse are free from retaliation;
    7. Notifying the health care provider’s licensing board(s) and the National Practitioner Data Bank of any disciplinary actions, in consultation with OGC and OHR or Servicing Regional Human Resource Offices;
    8. Reporting staff compliance with the training requirement annually to Area Directors by October 1; and
    9. Reviewing compliance with facility reporting practices described in this chapter.

  9. Supervisors. Ensure that all subordinate staff read and understand this policy and communicate its contents to their subordinate staff. On behalf of the CEO, Area Director, and Director, IHS, instills a positive attitude toward identifying, reporting, and preventing child sexual abuse throughout the facility. Holds all subordinate staff at all levels accountable for taking appropriate corrective action when allegations of child sexual abuse are reported. Requires all subordinate staff to collaborate and consult with the HHS OIG, IHS, and OHR when allegations of child sexual abuse are reported. All supervisors are responsible for:

    1. Ensuring that health care providers with a pending background investigation are within sight and under the supervision of a chaperone who has passed the required background investigation, at all times when they are in contact with, or have control over children;
    2. Keeping confidential, to the extent possible, the identity of the reporter of suspected child sexual abuse and taking steps to prevent retaliation;
    3. Ensuring all reported incidents of child sexual abuse are documented in the IHS Safety and Tracking Reporting (I-STAR) System by the reporting employee, or entering the information when an anonymous report is received;
    4. Ensuring completion of the required Agency-wide training on this policy during the orientation period, and annually, by September 29, thereafter, on the requirements of this policy and any local facility policy covering similar subjects to all staff under their supervision and maintaining a record of the training;
    5. Immediately removing a health care provider from any duties involving patient care interactions when a reasonable suspicion of child sexual abuse has been reported. Supervisors will follow Human Resources/OGC guidance for the reassignment, removal, or investigation of an employee and follow-through with recommended disciplinary action, if any; and
    6. Should a supervisor suspect a health care provider’s relationship with a patient or family member fails to meet professional guidelines, employee counseling or other disciplinary actions may be taken, including terminating the health care provider’s professional relationship with the patient or family and assigning the patient or family member to different providers.

  10. Health Care Provider. All health care providers in IHS facilities are responsible for:

    1. Reporting suspicions of child sexual abuse. If an IHS health care provider knows of, or has reasonable cause to suspect anyone, including another health care provider, has sexually abused or exploited a child, the health care provider is legally mandated to report to appropriate child protective services and/or law enforcement, HHS OIG Hotline 1-800-HHS-TIPS (1-800-447-8477), and the IHS Hotline 1-855-SAFE-IHS (1-855-723-3447);
    2. Limiting patient interactions to only those necessary to carry out their official duties and refraining from all activity that could be considered child sexual abuse, exploitation, or sexually inappropriate behavior;

    3. Maintaining appropriate patient and family boundaries, including:

      1. Limiting communication and contact to subjects related to the care of the child and services to meet health needs; and
      2. Refraining from any inappropriate contact outside of the scope of work, including but not limited to:
      1. Providing child care outside of their official IHS duties;
      2. Providing transportation in personal or Federal government vehicles to or from any location;
      3. Inviting children to locations away from the IHS-operated facility, or where other official duties are preformed, including staff housing;
      4. Sharing personal information or problems;
      5. Sharing personal contact information, including personal telephone numbers; physical addresses, and e-mail addresses;
      6. Interacting on social media;
      7. Accepting gifts, both monetary and non-monetary;
      8. Offering gifts, both monetary and non-monetary;
      9. Other social contact that is outside the patient-provider professional relationship; and
      10. Taking or possessing images of patients on personal devices at any time. Patient images obtained for patient health records will comply with the standard practice for photo-documentation.
    4. Ensuring at all times, prior to a receipt of a favorably adjudicated background investigation, when having contact with or control over children that they are within sight and under the supervision of a chaperone.
  11. All Staff. All Staff are responsible for:
    1. Reporting any incident or reasonable suspicion of child sexual abuse or exploitation by anyone, including a health care provider, directly to the appropriate child protective services and/or law enforcement, HHS OIG Hotline 1-800-HHS-TIPS (1-800-447-8477), and the IHS Hotline 1-855-SAFE-IHS (1-855-723-3447) within the same day of becoming aware of the incident;
    2. Reporting any incident or reasonable suspicion of child sexual abuse or exploitation by anyone, including a health care provider, directly to their supervisor, or alert the next supervisor in the chain of command if the first line supervisor is the one suspected of child sexual abuse within the same day of becoming aware of the incident;
    3. Documenting the report in the IHS Incident Reporting System (I-STAR), or whatever system is currently used by the IHS, within five business days of becoming aware of the incident; and
    4. Completing initial training and annual training on this policy as assigned.
11-2.3 CHAPERONES
  1. All staff designated as chaperones must have a favorably adjudicated background investigation on file as required under 25 U.S.C. § 3207 and 34 U.S.C. § 20351.
  2. All staff, including health care providers, who are pending a favorably adjudicated background investigation must be within sight and under the supervision of a chaperone when in contact with, or in control over children.
  3. Chaperones will be provided when requested by a patient or family member. A support person of the patient’s choosing, such as a family member accompanying a child may also be present in the examination room.
  4. Chaperones must be provided by IHS health care providers if the patient is a child and the examination requires inspection or palpation of anorectal areas, genital areas, or breasts.
  5. Chaperones should stand in a location where a chaperone is able to assist as needed and observe the examination or procedure without obstruction.
  6. The patient’s health record will clearly indicate the name of the chaperone and the time frame of the chaperone’s presence during the medical visit.
  7. If the examination requires a chaperone to be present and the patient refuses the presence of a chaperone, the patient or the family member will be given alternatives such as:
    1. Present options for the selection of a chaperone, such as gender-specific preference;
    2. Reassure patient or family member regarding staff adherence to the Health Insurance Portability and Accountability Act and Privacy Act laws;
    3. Limit presence of chaperone to only the parts of the patient’s physical examination required in this policy; and
    4. Address patient or family member concern with presence of chaperone.
  8. If the patient refuses the presence of a chaperone and the health care provider with a favorably adjudicated background investigation on file is willing to provide the requested health care examination without the presence of a chaperone, a health care provider note will document the patient refusal and will be co-signed by a second staff member that has verified the patient’s refusal. The health care provider can then proceed with the planned health examination.

    NOTE: Consult local facility policy regarding a minor patient’s ability to consent for medical procedures. Indian Health Manual, Part 3, Chapter 3, 3-3.14 Minors, 3-3.13C Consent to Examination in Sexual Assault Cases and the OGC can be consulted for additional guidance.

  9. If the patient refuses the presence of a chaperone and the health care provider is unwilling to provide the health care examination without the presence of a chaperone, or in circumstances of the health care provider not having a favorably adjudicated background investigation completed, an alternative health care provider will be provided when available, unless an emergency situation exists. (See section 11-2.3 G. above)
  10. All staff identified as chaperones will be available to the assigned health care provider to ensure minimal delay of patient care.
  11. All chaperones will be knowledgeable of this policy and immediately alert the patient and health care provider of a policy violation if observed and follow reporting requirements.
11-2.4 TRAINING REQUIREMENTS
  1. All Staff will:
    1. Complete Orientation. Successfully complete an Agency-approved training module on this policy upon initial entrance to duty and prior to any contact with patients or presence in patient care areas of facilities;
    2. Complete Annual Training. Upon annual notice (on or before August 1) by IHS, HQ, and OHR, to all IHS Organizational Leaders and Area Directors, all staff will be required to successfully complete annually an agency approved training module on this policy no later than September 29;
    3. Have access to Local Law Enforcement and Child Protection Contacts. Each staff member must be informed of the appropriate child protective services and/or law enforcement contact information for use at each location; and
    4. Have access to IHS Incident Reporting System. Each staff member must be informed where and how to access the I-STAR (or the current reporting system being used by the IHS) at each location.
  2. Federal Staff. The Learning Management System is set up for all Federal staff to access the required training, and automatically record the completion of the training by the Federal employee.
  3. IHS Contractors. Mandatory compliance with this policy will be included in all service contracts. Supervisors are responsible for ensuring any contractor placed under their supervision complete this training prior to patient contact and be accountable for ensuring compliance with and reporting of that training. Contractors will have access to the training materials.
  4. Students, Residents, and Volunteers. Mandatory compliance with this policy will be included in the terms of all agreements between the IHS and all entities sending individuals to the IHS for training and those entities or individuals that supply volunteer services to the IHS. Supervisors are responsible for ensuring any student, resident, and volunteer placed under their supervision completed this training prior to patient contact and be accountable for ensuring compliance with and reporting of that training. Students, residents, and volunteers will have access to the training materials.
  5. Tracking Training Completions.
    1. Headquarters Offices. Each HQ Office Director will track and report their office’s completion status to the Director, OHR, annually by October 7.
    2. Area Offices. Each Area Office Director will track and report their Area’s completion status to the DDFO, IHS, annually by October 3. DDFO will report IHS Area-wide annual training compliance annually to the Director, OHR, IHS, by October 5.
    3. Service Unit. Each Service Unit Director will track and report their Service Unit’s completion status to the Area Office Director annually by October 1.
11-2.5 STAFF RIGHTS

The health care provider under investigation will have complaints managed confidentially, sensitively, and expeditiously. The health care provider should be provided with independent, confidential support, and counseling services during the investigation.

  1. Investigation. In consultation with Human Resources and OGC, the health care provider under investigation must be immediately removed from direct patient care during an investigation. The health care provider under investigation may be assigned other non-patient care duties or placed on administrative leave.
  2. Confidentiality. Any allegations of child sexual abuse and related information will be maintained on a confidential basis to the greatest extent possible. The identity of the staff member reporting the alleged violations, as well as the health care provider under investigation, will be kept confidential, except as necessary to conduct an appropriate investigation into the alleged violation or when otherwise required by law.
  3. Reprisals Prohibited. Any attempt by any staff member as well as the health care provider under investigation, to restrain, interfere, coerce, or otherwise take reprisal action against another staff member who has reported the alleged violations is against the law. Such actions will result in disciplinary action, which can include termination, and will be reported to law enforcement.
  4. Grievance Process. Reports and actions pursuant to this policy do not replace, substitute, include, or otherwise satisfy the different forums that staff may utilize, including but not limited to the following processes: the negotiated grievance procedure; Agency grievance procedure; Merit Systems Protection Board; Equal Employment Opportunity; or any other statutory processes.