UI versus MUI in Ohio: what the rule actually says.

What is a major unusual incident (MUI)?

Under OAC 5123-17-02, a major unusual incident is the alleged, suspected or actual occurrence of one of the incidents the rule lists, when there is reason to believe it happened. The rule sorts them into three categories: Category A (abuse, neglect, exploitation and similar), Category B (medical emergencies, significant injuries, peer-to-peer acts and similar) and Category C (law enforcement, unanticipated hospitalisation, unapproved behavioural support).

The word "alleged" matters. An MUI is reportable when someone has reason to believe it occurred, not when it has been proven. The category decides who investigates and how fast; the facts uncovered can move an incident to a different category, and the rule requires the reason for any change to be documented.

What is an unusual incident (UI)?

An unusual incident is an event involving a person with a developmental disability that is not consistent with routine operations, policies and procedures, or the person's individual service plan, but is not a major unusual incident. Appendix F to the rule lists examples. UIs are reported inside the agency, investigated by the provider, logged, and reviewed at least monthly; they are not filed with the county board.

The rule adds one specific kind of UI, the "program implementation incident": a failure to carry out a person-centred plan that causes minimal or no risk, such as a short lapse in supervision, a vehicle accident without harm, or a person whose whereabouts were unknown for longer than the plan allows but who was never at imminent risk. Those are UIs, not MUIs, and they belong in the agency's UI log with a prevention plan.

What are Categories A, B and C?

Category A covers emotional abuse, exploitation, failure to report, misappropriation, neglect, physical abuse, prohibited sexual relations, rights code violations and unexplained or unanticipated death. Category B covers attempted suicide, death by natural cause, medical emergency, missing individual, peer-to-peer acts and significant injury. Category C covers law enforcement involvement, unanticipated hospitalisation and unapproved behavioural support.

A few definitions trip people up, so here they are as the rule states them.

• Neglect is failing, when there is a duty to act, to provide medical care, personal care or other support, with the result that a person dies, is seriously injured, or is placed at risk of serious injury; "serious injury" means an injury treated by a physician, physician assistant or nurse practitioner.
• Failure to report is itself a Category A incident: a developmental disabilities employee who does not immediately report the alleged, suspected or actual occurrence of abuse, neglect, exploitation or misappropriation has committed one.
• Peer-to-peer act (Category B) means exploitation, a physical act that results in medical examination or treatment or involves strangulation, a bloody nose or lip, a black eye, a concussion or biting that breaks the skin (or leads to arrest or charges), a sexual act without consent, or theft of property worth twenty dollars or more or of significant personal value.
• Significant injury (Category B) is an injury, of known or unknown cause, that needs dental treatment, or is a concussion, broken bone, dislocation, second- or third-degree burn, or requires immobilisation, casting or five or more sutures.
• Unanticipated hospitalisation (Category C) is an admission of forty-eight hours or longer, not connected to planned care, for aspiration pneumonia, bowel obstruction, dehydration, medication error, seizure or sepsis, or a readmission of forty-eight hours or longer for the same diagnosis as an admission within the previous thirty days.
• Unapproved behavioural support (Category C) is a prohibited measure, or a restrictive measure used without human rights committee approval or informed consent, when it results in risk to the person's health or welfare; without that risk it is investigated as a UI.

How fast must an MUI be reported?

Three clocks run at once. Any developmental disabilities employee reports the incident immediately to the agency's designated person, the county board's reporting system, or DODD's abuse and neglect hotline. For the incidents listed in paragraph (D)(7), the provider notifies the county board as soon as possible and no later than four hours after discovery. For every MUI, the provider submits the written incident report to the county board by 3 p.m. on the first working day after becoming aware of it.

The four-hour list is specific, and it is not the same as "Category A". Under (D)(7) it covers emotional abuse, exploitation, misappropriation, neglect, peer-to-peer acts, physical abuse, prohibited sexual relations, sexual abuse, unexplained or unanticipated death, and any media inquiry about an MUI. Peer-to-peer acts are Category B but sit on the four-hour list; rights code violations and failure to report are Category A but do not. The county board must run a reporting system that is available twenty-four hours a day, seven days a week, and must tell providers how to reach it. DODD's own abuse and neglect hotline, 1-800-617-6733, is staffed 8 a.m. to 5 p.m. Monday to Friday.

For Category C incidents, the provider submits the applicable administrative review form (appendix C for law enforcement, D for unanticipated hospitalisation, E for unapproved behavioural support) together with the incident report, at the same time. After a hospitalisation, the provider follows up with the hospital so that a diagnosis is known as soon as possible after forty-eight hours, files the incident report, and submits the appendix D form when the definition is met. The county board then enters the preliminary information in the Ohio Incident Tracking and Monitoring System (OITMS) by 5 p.m. on the first working day after it becomes aware of the incident.

What has to happen immediately, before any paperwork?

Immediately on identifying an MUI, the provider takes all reasonable measures to ensure the health and welfare of at-risk individuals, including securing medical attention and, where an employee is alleged to have been involved in physical or sexual abuse, removing that employee from direct contact with any individual. The measures taken, and by whom, go in the incident report.

Two other immediate duties sit alongside. When there is reason to believe a criminal act occurred, the provider reports it immediately to the law enforcement agency with jurisdiction over the location and records the date, time and name of the person notified. When the person is under twenty-one and the allegation is abuse or neglect, the local public children services agency is notified immediately; the provider or the county board may make that call, and the county board must ensure it happened.

Who else has to be told, and when?

On the same day the incident occurs or is discovered, the provider notifies, as applicable, the person's guardian or chosen representative, their service and support administrator, other providers whose services continue, and the staff or family at the person's residence. The notification includes the immediate actions taken, every notification or attempt is documented, and no notification goes to the primary person involved, their spouse or their partner.

Inside an agency provider, staff inform the director of operations or administrator within one working day of becoming aware of a potential or determined MUI involving misappropriation, neglect, physical abuse or sexual abuse. Notification is also not required where the report came from the person being notified, where notifying would itself endanger someone, or, in the case of a death, where the family already knows.

What goes in the incident report?

The rule defines the incident report's minimum contents: the person's name and address; the date, time and location; a description answering who, what, when and where; the type and location of injuries; the immediate actions taken for the person and any at-risk individuals; the primary person involved and their relationship to the individual; witnesses; written statements from witnesses and people with personal knowledge; every notification with name, title, date and time; medical follow-up; and the name and signature of the person completing it.

A report that covers those thirteen items on the first working day, before 3 p.m., in the format DODD prescribes, is the whole of the provider's filing duty for most incidents. Everything after that is investigation and prevention, which the county board's investigative agent leads.

Who investigates, and how long does it take?

Category A and B incidents get an administrative investigation by a county board investigative agent, initiated within twenty-four hours of the incident report for Category A and within three working days for Category B. Category C incidents get an administrative review, initiated within three working days of the review form. The agent's closure report is due in OITMS within forty-five working days of the incident report unless DODD grants an extension.

For allegations of physical or sexual abuse, the investigative agent works towards a preliminary finding within fourteen working days and tells the person or guardian and the provider; if that is not possible, they give a status update every seven working days. Agency and county board staff may help gather documents and enter information, but the agent conducts the interviews. Law enforcement or the children services agency can ask the agent to pause. DODD itself investigates when the allegation involves a county board superintendent, an investigative agent, a service and support administrator, an MUI contact, a board member, or a county board or developmental center employee alleged to be responsible for a death, sexual abuse, prohibited sexual relations, or abuse or neglect that led to emergency-room treatment or admission.

What happens after the investigation?

Within five working days of the recommendation to close, the county board (or DODD) sends a written summary — the allegations, facts and findings, whether the MUI was substantiated, and the prevention plan — to the person or guardian, the providers involved at the time, and the service and support administrator. The person, guardian or provider may dispute the findings within fifteen calendar days; the superintendent or director decides within thirty.

Agency providers must have a written procedure for internally reviewing every MUI and are responsible for reasonable measures to prevent recurrence. The team addresses the risks in the person's individual service plan and collaborates on the prevention plan; closure depends on whether reasonable measures were taken, the investigation was thorough, the prevention plan was implemented, and whether the incident is part of a pattern flagged in OITMS.

What is the annual MUI analysis due February 28?

Every agency provider must review the previous calendar year's MUIs for each county it served, analysing trends and patterns, and send the annual report to the county board by February 28. The report includes a three-year comparison, data by category, individuals with established patterns (for example five MUIs in six months or ten in a year), trends by residence, region or program, previously identified trends, and the action and prevention plans implemented.

County boards then review the report to ensure the issues were addressed, keep it on file for DODD, and convene a committee each March to review aggregate county data. The February 28 date is a hard one to miss quietly: it is the same for every agency in the state, and county boards notice absences.

What does the rule require for UIs?

Every agency provider needs a written UI policy that says what is reported as a UI, requires staff to report a UI to the designated person no later than twenty-four hours after it occurs, and requires the provider to investigate, identify causes and contributing factors, and put a prevention plan in place. Every provider keeps a UI log and reviews it at least monthly, noting months with no incidents.

The log records the person's name, a brief description, injuries, date, time, location, causes and contributing factors, and the prevention plan; it contains only UIs as the rule defines them. The provider delivering services when a UI occurs notifies other providers as needed for continuity of care. Independent providers complete a UI report, notify the guardian, and forward the report to the service and support administrator on the first working day after discovery. All staff must be trained on the policy.

How Enmantle handles UIs and MUIs

Enmantle's incident wizard walks a direct support professional through the report in three steps from a phone, captures photos, routes the incident to the right reviewer by type (UI, MUI or internal), and keeps the review queue, filings and follow-ups in one place so the four-hour and 3 p.m. clocks are visible rather than remembered.

Administrators review, file and track incidents from the same queue, and the annual analysis draws on the same records. The Help Center walks through both sides: reporting an incident and reviewing, filing and tracking UIs and MUIs.