Frequently Asked Questions
Mortality Review Committee FAQ's
What is the MRC?
The Mortality Review Committee (MRC) is one of many committees that make up the DDARS Quality Improvement Committee process which is managed by the Bureau of Quality Improvement Services (BQIS).
What does the MRC do with the information that they get? Or Why do we need the MRC?
By reviewing the information from each death, the MRC wants to make the changes necessary within each level to make the provision of services safer for all individuals. An important outgrowth of this process is recognition of best practices, and recommendations to implement those as systemic changes. The MRC knows that the information that is submitted for review can not change the circumstances that led to that individual's death. The MRC strives to use the information submitted for review in each case to identify trends, direct training needs, recommend development and/or modification of provider policies, or to modify state policies to address systemic issues that are seen during the review.
Who are the members of the MRC?
The Director of the Bureau of Quality Improvement Services chairs the MRC.
Members of the MRC that are external to the Division of Disability, Aging and Rehabilitative Services include a community physician who is experienced and understanding of the needs of individuals with developmental disabilities, a Registered Nurse representing the Office and Medicaid Policy and Planning, a representative from the Indiana State Department of Health; a representative from FSSA's General Counsel's Office; a professional representative who is experienced and understanding of the needs of individuals with developmental disabilities which is currently held by a representative from Indiana University Institute for Disability and Community; a community advocate for individuals with developmental disabilities, and a family member of an individual with a developmental disability.
Members of the MRC that are internal to DDARS include a Registered Nurse representing the Bureau of Aging and In-home Services (BAIHS); the DD Waiver Ombudsman; an Adult Protective Services Representative; Representatives from the Bureau of Developmental Disabilities Services, the Bureau of Strategic Support Services, and the Bureau of Quality Improvement Services.
Which deaths are reportable?
Basically, if you are required to file incident reports for the individual, then you are required to report their death to the MRC. The criteria that the MRC utilizes to determine if an individual's death must be reviewed is as follows:
Each death of an individual with developmental disabilities that occurs in:
- the State Developmental Centers;
- large private Intermediate Care Facilities for the Mentally Retarded;
- small private Intermediate Care Facilities for the Mentally Retarded;
- in community-based settings funded by a home and community based waiver, Title XX or the Bureau of Developmental Disability Services;
- in vocational programs funded by a home and community based waiver, Title XX or the Bureau of Developmental Disability Services;
- while receiving OBRA services and residing in a Nursing Care Facility;
- within 90 days of transferring from one of the listed services into a Nursing Care Facility; and
- those whose death occurred during a hospitalization from one of the above listed settings.
The individual:
- resided at home, or
- was only in our work program; or
- died at home; or
- only received respite services from us; or
- died and our staff were not working with the person when they died; or
- the individual had a terminal illness, or
- was elderly, their death was expected -
is their death reportable to the MRC?
Yes, all individuals that meet the criteria set forth in the MRC policy, regardless of the nature of their death, location of their death, level of the services that they received prior to their death are required to be reported to the MRC.
What do I do when an individual who meets the criteria dies?
The appropriate local authorities should be contacted immediately - 911, coroner, etc. to assist with the needs of the individual.
Then, in addition to the requirements for filing an incident report within 24 hours, you are required to make a phone call to BQIS Central Office - Ann Talbot at (317) 232-1046 within 24 hours and notify them of the death. If it is after normal business hours, leave a message at that number stating the name and social security number of the individual who passed, time and place of their death, your name and contact information, and the entity that the person was served by at the time of their death. This will assure that the MRC is notified of the death.
Who is responsible for completing the notification packet?
All providers of services to the individual when they pass are required to provide information about the services provided.
- In ICF/MR facilities, the executive director of the ICF/MR facility is responsible for the completion of the MRC Notification packet.
- In Supported Living settings; the provider who is identified as providing Health Care Coordination Services for the individual or if that is not a service provided to the individual, the provider who is identified in the ISP as responsible for the health care of the individual.
How do I get the notification packet?
Each and every time that you report a death on a BDDS incident report form, the appropriate entity will be sent the notification packet to complete. Hopefully, you will not be reporting deaths very often, and the requirements for the information packet may change between the time that you need it. For the current notification packet, always refer to the website or wait until it is sent to you by BQIS.
Does the MRC really want all that information?
YES, copies of all original documentation requested in the notification packet is what the MRC requires to complete their review. This includes documentation of all services provided to the individual by all providers of those services. You should not retype documentation, if you feel the need to type up hand written documentation you must state that it is typed and also submit the copies of the hand written originals. Summaries of documentation should be submitted as part of your internal review, however copies of all original documents reviewed in the summary should be submitted with the notification packet.
The process is intrusive to families, why do we have to talk to them about this review for the state when they are grieving the loss of their family member?
We understand that this time is very hard on families, but from the feedback that we have been given by consumer and family member groups, the families do not mind providing the information when they know that the purpose of our review is to make sure that not only the care provided to their family member was adequate, but to make sure that we can make the system better for others.
However, we understand that all families may not feel this way. It is for that reason that we allow the family to decline, as documented on the release form sent to the provider with the MRC notification packet.
We urge you to use tact and your best judgment in approaching families and educating them out this process either prior to the need to submit the packet arises or when you are completing the packet.
The family signed the release form, indicating that the hospital should send the information to the MRC directly - do I just send that in with the packet?
No, It is the responsibility of the provider who is completing the packet to request that the information be sent to the MRC and to follow up to assure that the information has been sent.
I'm being told that the autopsy will not be available for 6 weeks and the notification packet is due in 15 days - what do I do?
Contact Lynn Underwood at Lunderwood@fssa.state.in.us or (317) 234-1146 - let her know what is happening and the target date that you were told the information will be available.
We understand that in some rare occurrences, all information required in the notification packet will not be available within 15 days. We ask that you send in everything that you have, and provide us with regular updates on getting the remainder of the information. We will work with you if you are communicating with us your efforts to gather the information that is not under you direct control.
What medical information needs be submitted?
The MRC reviews the following medical information for the period 12 months prior to and including the individual's date of death:
- Last physical completed by a physician,
- Physician consults/referrals,
- Diagnostic tests and Lab tests completed.
What chronological data should be submitted with the packet?
The MRC reviews the following documentation for 30 days prior to the individual's death (if the death occurred in a hospital, the MRC will review documentation for the last 30 days of service provided).
- Doctor/Nurses notes
- Progress notes
- Daily Log Sheets
- Training Programs offered and staff attendance records
- Staffing schedules up to and including the date of the consumer's death.
The information requested includes documentation from Case Managers, Day/Habilitation Providers and Residential providers.
OK, I completed the notification packet, now what?
As the MRC only meets on a monthly basis, depending on when your packet was completely submitted, may be up to 2 months prior to the MRC review being completed. You will be sent notification when the MRC completes their review.
When the MRC reviews the information they will
- note if there were no concerns, or
- note if they felt that the documentation showed a best practice situation, or
- make systemic recommendations due to concerns which are sent for review and action to the Quality Improvement Executive Council, or
- make specific recommendations to provider agencies to address concerns noted during the review, or
- refer their concerns to the appropriate regulatory entity, such as the Indiana State Department of Health; the Health Professions Board or the Attorney General's office.
