MAX IM Bulletin Comments

Office of Developmental Programs

Department of Human Services

Incident/Risk Management Unit

Room 411

Health and Welfare Building

625 Forster Street

Harrisburg, Pa  17120

July 31, 2019

Re:  MAX Association comments on the draft Incident Management Bulletin

MAX and its membership thank you for the opportunity to comment on this important draft bulletin that is a critical part to monitoring safety for individuals with intellectual disabilities and autism.  The comments in this cover letter expressing general concerns as well as the more detailed point by point attachment reflect the input of the collective membership of MAX Association.

MAX certainly believes in the importance of and promotes keeping people safe.  However, MAX concludes after thorough review, that this draft bulletin on Incident Management may be counter-productive to that very intent.  Furthermore, MAX presupposes that if this draft bulletin is approved in its current form, it will pose a significant and increased risk to individuals.

This draft bulletin will require an estimated quadrupling of incident reporting and investigations for providers.  This will mean much more time being required to completing substandard investigations “just to get them done” as well as already severely stretched resources being diverted from services- the very mission why providers exist – to investigations. It will also intensify the indubitable current workforce crisis, potentially simultaneously suspending the entire staff of programs.  It will also increase ODP’s liability as now all this information in the form of investigations will be sent without ODP having the system and capability to adequately review and triage the information.

MAX believes instead of creating all this superfluous paperwork, that we look at the information we already have about incidents and do a root cause analysis.  MAX surmises that if we did this, that one of the major trends that would emerge would be around the Fatal Four.  MAX recommends that instead of adding to the pile of information through increased reporting that a deep dive be done with the data we already have and invest resources into preventing future incidents rather than reporting occurrences that, in reality, pose no risk.

Additionally, there are many places in this draft bulletin where ODP far exceeds the requirements of the regulation it is based upon, placing undue administrative and financial burden on providers.  MAX strongly urges ODP to remove all such requirements.

Finally, MAX requests that ODP not move forward to finalize this bulletin until after the 6100’s are promulgated as final and after providers have an opportunity to review the draft bulletin and the final regulations together in order to provide complete comments. This will allow all stakeholders the optimal opportunity to identify areas of question or concern. Without the final regulations fully informed comments on this draft bulletin are not possible.

Please also find attached specific and detailed comments on the draft bulletin.

Again, thank you for the opportunity to provide comments.


Diane Conway, Ph.D.

Executive Director

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