Department of Aging and Disability Services Council
Prescribed Pediatric Extended Care Center Licensing Rules
March 6, 2014
Good morning. My name is Erin Lawler and I am a Public Policy Specialist with the Texas Council for Developmental Disabilities. TCDD is established by federal law and is governed by 27 board members, appointed by the Governor, 60% of whom are individuals with developmental disabilities or family members of individuals with disabilities. The Council’s purpose in law is to encourage policy change so that people with disabilities have opportunities to be fully included in their communities and exercise control over their own lives.
Thank you for the opportunity to provide comments on the Prescribed Pediatric Extended Care Center licensing rules. Thank you also to the DADS staff who have worked diligently on this rulemaking despite tight deadlines and complicated issues. We appreciate the places in the latest draft rule where revisions have been incorporated related to the safety and well-being of children, but there are several significant issues outstanding.
While we appreciate that DADS accepted many of our recommendations about expanding the rules on the use of restraint, we believe that the training requirements for PPECC staff members related to restraint are still too vague. Section 15.2007(h) simply requires staff to be “properly trained in the use of the restraint for a minor as ordered in the minor’s plan of care and in accordance with this section.” Safely restraining anyone requires training about the human airway, muscle groups, and joints, among other things. Safely restraining a child with complex medical needs requires even more sophisticated training. At a minimum, DADS should revise the rule to require that staff members who have direct contact with children receive hands-on training and demonstrate competence in the safe use of restraint and alternatives to restraint, including conflict resolution skills. DADS should require that staff members demonstrate competencies in these areas on a semi-annual basis and that restraint training providers are qualified by education and experience.
Second, we continue to have concerns about a potential conflict of interest scenario permitted by this rule. The draft rule allows for the medical director of a PPECC to also act as a child’s prescribing physician. This places a single person in the difficult position of balancing an employee’s loyalty to an employer with a doctor’s fiduciary duty toward his patient. Revising the rules to ensure that each child served in a PPECC benefits from the services of both the PPECC’s medical director and an outside prescribing physician will not only provide oversight, it will avoid the appearance of impropriety.
Stakeholders and DADS staff alike felt the pressure of attempting to create a functional rule under this condensed timeline. We believe that the current draft of the rule has improved substantially from where it started, but addressing the two areas I have highlighted would further improve it. We are crafting a rule that will affect children with complex medical needs and we must be mindful of the time and effort required to do so.
We look forward to working with DADS to continue to improve the rule during the upcoming comment period.