413-020-0640 Investigation When additional information is necessary to substantiate a conclusion to the medical neglect report, the Medical Neglect Investigator shall form a special investigative team with a consultant neonatologist from a hospital other than the one where the infant is receiving care, a local CPS caseworker and any other necessary professionals such as a nutritionist or the local district attorney. The on-site investigation shall be completed in the shortest possible time. (1) The Medical Neglect Investigator, with the assistance of the special investigation team members and designated hospital liaison, will complete the following: (a) Interview treating physicians and others involved in the treatment; (b) Arrange as early as possible meeting with HRC or other hospital review boards or committees. Determine at minimum the following: Did the HRC verify the diagnosis? How were the parents involved in the process? What treatment alternatives exist? (c) Review medical records. The parents shall be requested to sign a release of information to allow CPS investigation and/or medical consultant to review records. If determined necessary, court intervention may be used to give access to medical records; (d) Interview parents (after first determining with hospital social worker appropriateness and context for interviewing parents) to determine the parent’s understanding of the child’s condition and treatment alternatives, the decisions they have made, and the basis for those decisions. (2) When necessary, the Medical Neglect Investigator may take the following actions: (a) Make an on-site visit to the medical facility to observe the care and treatment being provided to the infant; (b) If an alternative diagnosis was not entertained, and no consultants brought in, or there was not a procedure for reviewing the diagnosis and treatment recommendation, then the investigator may wish to arrange for an independent medical consultant and/or exam. The Medical Neglect Investigator shall recommend to the parent(s) that an independent medical examination or evaluation be performed. If the parent(s) do not consent, the specialist will seek a court order to obtain an independent medical examination or evaluation. (3) Concluding the Investigation: (a) Following the investigation, the Medical Neglect Investigator will determine: (A) Whether the report of suspected medical neglect of the handicapped infant with life-threatening conditions is valid. Information from the HRC or consulting physicians, including the Designated Consultant Neonatologist, shall be used to determine whether the treating physician exercised reasonable medical judgment. The reasonable medical judgment of the treating physician may differ from that of other physicians. Grounds for overriding the refusal of the parents of the infant to consent to medical care and treatment exist only if any reasonable medical judgment would be that treatment is medically indicated. The parents’ refusal to consent shall be respected if the attending physician, the Review Committee, or a consulting physician finds that treatment is not medically indicated; (B) Whether further action should be taken by the Department, and if there is a basis for juvenile court jurisdiction. (b) If the parents of the infant refuse to consent to the medical care and treatment found to be necessary and adequate by the attending physician and the HRC, or by another consulting medical professional, or the attending physician refuses to provide treatment, Child Welfare shall initiate the filing of a petition in juvenile court on behalf of the infant requesting the court to take jurisdiction of the infant so that medically indicated treatment may be provided. Child Welfare will also request that a Guardian Ad Litem (GAL) or Court Appointed Special Advocate (CASA) be appointed for the child. The caseworker will document these actions in the case record; (c) If the infant’s parents do not desire medical treatment beyond that being provided and if the reasonable medical judgment of the attending physician, HRC, or other consulting medical professional is that medically indicated treatment is being provided, the Medical Neglect Investigator will document this agreement in the case record. The CPS caseworker will close the case and take no further action; (d) If the infant’s parents desire medical care or treatment for the infant which is not being provided by the attending physician or the medical facility, the Medical Neglect Investigator will advise the parents of their option to seek another medical opinion or additional medical resources. The Medical Neglect Investigator shall document the advice given the parents in the case record, the caseworker will close the case and take no further action; (e) The Child Welfare caseworker shall assist the parent(s) with referrals to support groups, community educational resources, and agencies which provide services for disabled infants and their families, and to agencies with financial resources for medical and rehabilitative services; (f) Following completion of the investigation, the Medical Neglect Investigator shall notify the assistant administrator for the Program Operations by telephone of the report, the investigation and the actions taken. The telephone report is to be followed by a written report and documented in the case record. Statutory/Other Authority: ORS 418.005 Statutes/Other Implemented: ORS 418.005 History: SCF 6-1995, f. 12-22-95, cert. ef. 12-29-95