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11000 Death of a Client

APS January 2022

APS does not investigate allegations of abuse, neglect, or financial exploitation when the client is already deceased at the time the allegation is made, except when there is already an open APS case.

Client Dies During an Open Case

When a client dies during an open case, the APS specialist consults with the supervisor and, when appropriate, the subject matter expert to determine whether the client’s death was caused by one of the following:

  • Self-neglect, an accident, or natural causes.
  • Abuse or neglect by a perpetrator.

If it is suspected that abuse or neglect by a perpetrator contributed to the client’s death, see 11200 Client’s Death May Involve a Perpetrator.

In some cases, the available evidence may indicate that both caretaker neglect and self-neglect are present. The APS specialist uses the evidence, including information from medical professionals, to determine whether actions or inaction by a perpetrator contributed to the client’s death.

If the case involves misconduct or violation of law or DFPS policies by a DFPS employee, APS notifies the HHSC Office of the Inspector General, as outlined in 11300 Notifying the Office of the Inspector General.

The following table gives examples of different situations involving a client’s death and which policies to follow:

Allegations at Intake

Client’s Death

Policy to Follow

Self-neglect by the client because he or she is unable to pay the water bill.

Client died of a heart attack.

11100 Client’s Death is Related to Natural Causes, Accident, or Self-Neglect

HCSSA caretaker physically abused the client, causing internal injuries and broken bones.

Client died as a result of the injuries.

11220 Perpetrator’s Actions May Have Contributed to the Client’s Death

Client’s son, who is also her caretaker, is not getting the client’s prescriptions refilled.

Client died in a car accident caused by an unrelated driver.

11210 Perpetrator’s Actions Did Not Contribute to Client’s Death

Client is being financially exploited by her granddaughter, who is also her paid HCSSA caretaker.

Client died from emphysema (not related to the financial exploitation allegation).

When the Perpetrator Is EMR-Eligible in 11200 Client’s Death May Involve a Perpetrator

Client is diabetic and refuses to take proper doses of insulin when needed. The client’s son is the caretaker, and he fails to get the client out of bed for days.

Client developed sepsis and died.

11220 Perpetrator’s Actions May Have Contributed to the Client’s Death

Client Dies Before the Initial Face-to-Face Contact Is Completed

The APS specialist is not required to complete an Initial Face-to-Face Contact Detail page, Safety Assessment, or Risk of Recidivism Assessment when either of the following occurs:

  • The client dies before the APS specialist can complete an initial face-to-face contact.
  • A case is open, and APS receives a new intake after the client’s death.

The APS specialist conducts and documents the case initiation and all other contacts necessary to complete the case.

See 9400 Initial Face-to-Face Contact With the Client.

11100 Client’s Death Is Related to Natural Causes, Accident, or Self-Neglect

APS January 2022

When a client dies during an open case and the death is related to natural causes, an accident, or self-neglect, the APS specialist does the following:

  • Consults with the APS supervisor.
  • Assesses whether it will be possible to reach a disposition with the available evidence.

If there is not sufficient information available at the time of death to reach a disposition, the APS specialist closes the case using rapid closure procedures (see 11110 Rapid Closure When Client’s Death is Related to Natural Causes, Accident, or Self-Neglect).

If sufficient information is available at the time of death to reach a disposition, the APS specialist does the following:

  • Determines the validity of the allegations based on a preponderance of the available evidence.
  • Documents the client’s death in IMPACT as outlined below.

Documentation of Death Resulting from Natural Causes or Accident

If the client’s death was a result of natural causes or an accident, the APS specialist does the following:

  • Documents the case and all consultations as required by policy.
  • Records the date of the client’s death on the Person Detail page in IMPACT.
  • Chooses APS – Not Related to A/N as the Reason for Death in the drop-down menu on the Person Detail page.
  • Chooses Client Died as the closure reason on the Case Closure page.

The APS specialist is not required to complete the Risk of Recidivism Assessment or Strengths and Needs Assessment.

See:

9000 Case Contacts

13100 Case Closure Codes

Documentation of Death Resulting from Self-Neglect

If the client’s death was a result of self-neglect, the APS specialist does the following:

  • Documents the case and all consultations as required by policy.
  • Records the date of the client’s death on the Person Detail page in IMPACT.
  • Chooses APS – UTD/INC as the Reason for Death in the drop-down menu on the Person Detail page.
  • Chooses Client Died as the closure reason on the Case Closure page.

The APS specialist is not required to complete the Risk of Recidivism Assessment or Strengths and Needs Assessment.

See 13100 Case Closure Codes.

11110 Rapid Closure When Client’s Death Is Related to Natural Causes, Accident, or Self-Neglect

APS January 2022

The APS specialist, in consultation with the supervisor, uses rapid closure procedures after a client’s death when both of the following criteria are met:

  • The client’s death was related to natural causes, an accident, or self-neglect.
  • There is not sufficient information at the time of the client’s death to reach a disposition of Valid, Invalid, or Unable to Determine.

See 11100 Client’s Death is Related to Natural Causes, Accident, or Self-Neglect.

Documentation of Rapid Closure

When using rapid closure procedures, the APS specialist does the following:

  • Completes Section 1 of the Safety Assessment, including the case initiation contact information.
  • Consults with the supervisor about the appropriateness of using rapid closure procedures and documents the discussion.
  • Enters Other (OTH) as the disposition for each self-neglect allegation.
  • Records the date of the client’s death on the Person Detail page in IMPACT.
  • Chooses APS – UTD or INC as the Reason for Death in the drop-down menu on the Person Detail page.
  • Chooses Client Died as the overall closure reason on the Case Closure page.

The APS specialist is not required to complete Sections 2-5 of the Safety Assessment, the Risk of Recidivism Assessment, or the Strengths and Needs Assessment.

See 13100 Case Closure Codes.

11200 Client’s Death May Involve a Perpetrator

APS January 2022

When a client dies during an open case that includes an allegation against a perpetrator, the APS specialist consults with the supervisor and, as needed, the subject matter expert to review the available evidence to determine both of the following:

  • Whether the client’s death was caused by abuse or neglect by a perpetrator.
  • Which of the following applies to the allegation:
    • Not previously alleged during the case.
    • Alleged but not validated during the case.
    • Alleged and validated during the case.

If it is suspected that abuse or neglect by a perpetrator contributed to the client’s death, the APS specialist does the following:

    • Immediately reports the situation to the appropriate law enforcement agency.
    • Follows policy in 2332 High-Profile Cases within 24 hours of learning of the client’s death.
    • Continues the investigation unless law enforcement requests otherwise.

When the Perpetrator Is EMR-Eligible

If a client dies during an open case involving a perpetrator who is eligible for placement on the Employee Misconduct Registry (EMR), the APS specialist cannot use rapid closure procedures. The APS specialist continues the investigation and, based on the available evidence, reaches a disposition (finding), regardless of whether it is suspected the perpetrator contributed to the client’s death.

It is important to make sure that an EMR-eligible perpetrator is referred to the EMR if there is a Valid allegation that rises to the level of reportable conduct. For example, if there are allegations of financial exploitation and abuse against a HCSSA caretaker, then APS continues the investigation after the client’s death. If the evidence supports a disposition of Valid-Reportable Conduct, APS refers the perpetrator to the EMR, even if there is not sufficient information to determine whether the perpetrator contributed to the client’s death.

If it is clear the actions of the perpetrator did not contribute to the client’s death, such as if the only allegation is financial exploitation, APS still refers the perpetrator to the EMR if the evidence supports a disposition of Valid-Reportable Conduct. See the table in 11000 Death of a Client.

The APS specialist continues and completes the investigation (or, if it is not possible to continue the investigation, uses the available evidence) and reaches a disposition of Valid, Invalid, or Unable to Determine. See the table in 11000 Death of a Client.

See:

Appendix IV: Decision-Making Trees – If the Client Dies

14400 Employee Misconduct Registry (EMR)

New Intake With Allegations Against a Perpetrator Is Received Before Client’s Death

The APS specialist consults with the supervisor when all of the following occur:

  • APS received a new intake report before the client’s death.
  • The client dies while the new case is open.
  • The original case is still open.

If neither the APS specialist nor the supervisor suspects a perpetrator contributed to the client’s death, the APS specialist does the following:

If the APS specialist or supervisor suspects that a perpetrator may have contributed to the client’s death, the APS specialist does the following:

See 15252 Merging Cases.

11210 Perpetrator’s Actions Did Not Contribute to Client’s Death

APS January 2022

If the client dies before APS reaches a disposition and the APS specialist does not suspect the perpetrator’s actions or inaction contributed to the client’s death, then the APS specialist does the following:

  • Consults with the APS supervisor.
  • Assesses whether it will be possible to reach a disposition with the available evidence.

If there is not sufficient information available at the time of death to reach a disposition, the APS specialist closes the case using rapid closure procedures (see 11211 Rapid Closure When the Perpetrator’s Actions Did Not Contribute to the Client’s Death).

If sufficient information is available at the time of death to reach a disposition, the APS specialist does the following:

  • Determines the validity of the allegations based on a preponderance of the available evidence.
  • Documents the client’s death in IMPACT, as outlined below.

Documentation When Perpetrator’s Actions Did Not Contribute to Client’s Death

If abuse or neglect by a perpetrator did not contribute to the client’s death, the APS specialist does the following:

  • Documents the case and all consultations as required by policy.
  • Records the date of the client’s death on the Person Detail page in IMPACT.
  • Chooses one of the following as the Reason for Death in the drop-down menu on the Person Detail page:
    • APS – Not Related to A/N (not related to abuse or neglect). The APS specialist chooses this reason if a preponderance of the evidence shows a perpetrator did not contribute to the client’s death, including when the death is from natural causes or an accident.
    • APS – UTD or INC (undetermined or inconclusive). The APS specialist chooses this reason when a client dies of self-neglect, or the available evidence does not indicate whether the death was related to abuse or neglect.
  • Chooses Client Died as the closure reason on the Case Closure page.

The APS specialist is not required to complete the Risk of Recidivism Assessment or Strengths and Needs Assessment.

See 9000 Case Contacts.

11211 Rapid Closure When the Perpetrator’s Actions Did Not Contribute to the Client’s Death

APS January 2022

The APS specialist consults with the supervisor before using rapid closure procedures.

In cases involving a perpetrator, the APS specialist may use rapid closure procedures after a client’s death when all of the following apply:

  • There is not sufficient information available at the time of death to reach a disposition for the allegations.
  • The perpetrator did not contribute to the client’s death.
  • The perpetrator is not a paid caretaker employed by a Home and Community Support Services Agency (HCSSA) and, therefore, is not eligible for the Employee Misconduct Registry (EMR).
  • The APS specialist has no reason to believe the perpetrator is an ongoing threat to other people over age 65 or adults with disabilities.

See 11210 Perpetrator’s Actions Did Not Contribute to Client’s Death.

Documentation When Using Rapid Closure Procedures

When using rapid closure procedures, the APS specialist does the following:

  • Completes Section 1 of the Safety Assessment, including the case initiation contact information.
  • Enters Other (OTH) as the disposition for each allegation on the Allegation Detail page.
  • Records the date of the client’s death on the Person Detail page.
  • Chooses APS – UTD or INC as the Reason for Death in the drop-down menu on the Person Detail page.
  • Documents the supervisory consultation.
  • Chooses Client Died as the overall closure reason on the Case Closure page.

The APS specialist is not required to complete Sections 2-5 of the Safety Assessment, the Risk of Recidivism Assessment, or the Strengths and Needs Assessment.

See 13100 Case Closure Codes.

11220 Perpetrator’s Actions May Have Contributed to the Client’s Death

APS January 2022

When the client dies before APS reaches a disposition and the APS specialist or APS supervisor suspects a perpetrator’s act of abuse or neglect contributed to the client’s death, the APS specialist does the following:

  • Immediately notifies law enforcement by phone.
  • Sends the LE Form Suspected (located in IMPACT).
  • Shares case-related information with law enforcement and provides assistance as requested.
  • Follows policy in 2332 High-Profile Cases within 24 hours of learning of the client’s death.

The APS specialist is not required to complete the Safety Assessment, Risk of Recidivism Assessment, or Strengths and Needs Assessment.

Law Enforcement Requests APS Discontinue Investigation

If law enforcement requests that APS discontinue the investigation, the APS specialist does the following:

  • Documents law enforcement’s request in IMPACT.
  • Sends the LE Form Conclusion to the appropriate law enforcement agency.
  • Consults with the supervisor to determine whether either of the following applies:
    • Law enforcement is willing to share information that will allow APS to reach a disposition of Valid or Invalid.
    • There is not sufficient evidence to reach a preponderance, and APS will close the case with a disposition of Unable to Determine.

Law Enforcement Does Not Request APS Discontinue Investigation

If law enforcement does not request that APS discontinue the investigation, the APS specialist does the following:

      • Continues the investigation by interviewing people not already interviewed or who need to be re-interviewed, including the reporter, other collaterals, and the perpetrator.
      • Consults with the subject matter expert, as appropriate.
      • Determines the validity of the allegations based on a preponderance of the available evidence or enters an allegation disposition of Unable to Determine if the available evidence is not sufficient.
      • Sends the LE Form Conclusion to the appropriate law enforcement agency.
      • Uses any available resources, such as medical professionals and coroners, to determine the cause of death and whether or not the perpetrator’s actions or inaction contributed to the client’s death.

Additional Actions Before Case Closure

The APS specialist determines the Reason for Death in IMPACT based on the disposition of the allegation and any expert testimony about the client’s cause of death. It is possible to validate an allegation but still find that the perpetrator’s actions did not contribute to the client’s death.

If no expert testimony is available, the APS specialist uses his or her judgment in consultation with the supervisor and, as appropriate, the subject matter expert to determine the Reason for Death.

Regardless of the disposition or the reason for death, the supervisor adds the program administrator or subject matter expert as a secondary approver in IMPACT when reviewing a case for closure in which the APS specialist or supervisor suspects the perpetrator’s actions may have contributed to the client’s death.

See:

11400 Adult Fatality Review Team

13100 Case Closure Codes

Documentation When the Perpetrator’s Actions May Have Contributed to the Death

The APS specialist does the following in IMPACT:

  • Documents in Contact Detail narratives the client’s death and any evidence collected to establish a preponderance to make a disposition.
  • Enters the appropriate disposition for each allegation.
  • Checks the box on the Allegation Detail page that says “This allegation contributed to the client’s death” for any allegation with a disposition of Valid that contributed to the client’s death. This box appears once the APS specialist chooses Valid as the allegation disposition.
  • Enters any external documentation, including photos, on the External Documentation page or in OneCase.
  • Records the date of the client’s death on the Person Detail page.
  • Chooses one of the following reasons for the client’s death in the Reason for Death drop-down menu on the Person Detail page:
    • APS – Related to A/N (related to abuse or neglect by a perpetrator).
    • APS – Not Related to A/N (not related to abuse or neglect). The APS specialist chooses this reason if a preponderance of the evidence shows a perpetrator did not contribute to the client’s death, including when the death was from natural causes or an accident.
    • APS – UTD or INC (undetermined or inconclusive). The APS specialist chooses this reason when a client dies of self-neglect, or the available evidence does not indicate whether the death was related to abuse or neglect.
      • Documents all case contacts as required by policy.
      • Chooses Client Died as the closure reason on the Case Closure page.

The APS specialist is not required to complete the Risk of Recidivism Assessment.

See:

8400 Referrals to Law Enforcement

11100 Client’s Death is Related to Natural Causes, Accident, or Self-Neglect

13100 Case Closure Codes

14100 Desk Review

14300 Due Process for Non-EMR (Employee Misconduct Registry) Cases

14400 Employee Misconduct Registry (EMR)

11221 Client’s Death May Involve Valid Allegations Against a Perpetrator

APS January 2022

The APS specialist takes certain actions when a client dies during an open case and the original allegation meets either of the following criteria:

  • Ongoing neglect by the caretaker that was found to be Valid.
  • A specific incident of abuse by a perpetrator that was found to be Valid.

If a case meets the criteria above, the APS specialist does the following:

  • Consults with the supervisor.
  • Makes any additional contacts necessary to establish the reason for death.
  • Documents the case as outlined in policy.

If the APS specialist determines that the validated allegation contributed to the client’s death, the APS specialist follows the directions in the subsections below before closing the case. See 2332 High-Profile Cases.

Regardless of the disposition or the reason for death, the supervisor adds the program administrator or subject matter expert (SME) as a secondary approver in IMPACT for closing the case.

Examples of When a Death May Involve a Validated Allegation

The following are examples of validated allegations that may have contributed to a client’s death during an open case:

  • Neglect because the perpetrator has not been feeding a client who is non-ambulatory, and this has been ongoing.
  • Abuse when the perpetrator kicked and choked the client, and there have been no subsequent incidents of abuse.

Documentation When a Client’s Death May Involve Allegations Validated During the Case

If a client dies during the case after APS has found the original allegations to be Valid for neglect or for a specific incident of abuse by a perpetrator, the APS specialist does the following in IMPACT:

  • Documents all contacts made while investigating the reason for the client’s death, including narrative information, as outlined in 9100 Requirements for Contacts and 9110 Time Frame for Entry of Contacts.
  • Enters any external documentation, including photos, on the External Documentation page or in OneCase.
  • Records the date of death on the Person Detail page.
  • Records the appropriate reason for death in the Reason for Death drop-down menu by choosing one of the following:
    • APS – Related to A/N — Related to abuse or neglect by a perpetrator.
    • APS – Not Related to A/N — Not related to abuse or neglect (used when a perpetrator did not contribute to the client’s death).
    • APS – UTD or INC — Undetermined or inconclusive (used when the client dies of natural causes, an accident, or the actions of the client in valid self-neglect cases, or when the available evidence does not indicate whether the death was related to abuse or neglect).
  • Chooses Client Died as the closure reason on the Case Closure page.

The APS specialist is not required to complete the Risk of Recidivism Assessment or Strengths and Needs Assessment.

11222 Client’s Death May Involve New Incidents Related to Allegations Investigated or Validated During the Case

APS January 2022

The APS specialist follows the steps below when a client dies during an open case, allegedly as a result of either of the following:

  • A new incident of an allegation against a perpetrator that was validated during the current case.
  • An allegation that was investigated but not validated during the current case.

In either of these situations, the APS specialist does the following:

If an allegation’s disposition is changed to Valid as a result of the new investigation, the APS specialist also makes sure that the perpetrator is given the opportunity to request a desk review or due process hearing.

See:

14000 Due Process and Release of Information

14100 Desk Review

14300 Due Process for Non-EMR (Employee Misconduct Registry)

14400 Employee Misconduct Registry (EMR)

14500 Cases Involving School Personnel

Examples of When a Death May Involve New Incidents of Investigated or Validated Allegations

The following are examples of a new incident of an allegation investigated or validated that may have contributed to a client’s death during the currently open case:

  • Abuse was validated in the case when the perpetrator broke the client’s arm, but later the perpetrator hit the client on the head with a cane. The client then died, allegedly as a result of the head injury. This would be the same allegation, but a new incident.
  • Financial exploitation and abuse were both investigated in the case, but only financial exploitation was validated. During the case, the client dies, allegedly as the result of abuse.

Documentation When a Client’s Death May Involve New Incidents of Allegations Investigated or Validated During the Case

The APS specialist does as follows in IMPACT:

  • Documents all contacts made while investigating the reason for the client’s death, including narrative information, as outlined in 9000 Case Contacts.
  • Enters any external documentation, including photos, on the External Documentation page or in OneCase.
  • Records the date of death on the Person Detail page.
  • Chooses the appropriate reason for death in the Reason for Death drop-down menu on the Person Detail page:
    • APS – Related to A/N — Related to abuse or neglect by a perpetrator.
    • APS – Not Related to A/N — Not related to abuse or neglect (used when a perpetrator did not contribute to the client’s death).
    • APS – UTD or INC — Undetermined or inconclusive (used when the client dies from self-neglect or the available evidence does not indicate whether the death was related to abuse or neglect).
  • Chooses Client Died as the closure reason on the Case Closure page.

If the APS specialist determines that abuse or neglect by a perpetrator contributed to the client’s death during the open case, the APS specialist refers to 11222.1 Corrections to the Allegation Detail When Investigated Allegations Contribute to a Client’s Death before closing the case.

Regardless of the disposition or the reason for death, the supervisor adds the program administrator or subject matter expert as a secondary approver in IMPACT for closing the case.

The APS specialist is not required to complete the Risk of Recidivism Assessment or Strengths and Needs Assessment.

11222.1 Corrections to the Allegation Detail When Investigated Allegations Contribute to a Client’s Death

APS January 2022

The APS specialist follows these procedures when the situation meets all of the following criteria:

  • A client dies during the case.
  • An allegation involving a perpetrator was investigated during the current case.
  • A new incident related to the original allegation contributed to the client’s death.

If the criteria above are met, the APS specialist does the following:

  • Changes the disposition (finding) for the appropriate allegation to Valid on the Allegation Detail page, if it was not already Valid.
  • Marks the box indicating that the allegation contributed to the client’s death on the Allegation Detail page to accurately reflect that abuse or neglect contributed to the death.
  • Chooses APS – Related to A/N as the Reason for Death on the Person Detail page.

See:

11220 Perpetrator’s Actions May Have Contributed to the Client's Death

11222 Client’s Death May Involve New Incidents Related to Allegations Investigated or Validated During the Case

11223 Client’s Death May Involve New Allegations Against an Alleged Perpetrator

APS January 2022

The APS specialist follows these procedures when the situation meets both of the following criteria:

  • A client dies during the case.
  • The client’s death may be the result of a new allegation of abuse or neglect by a perpetrator that was not previously alleged or investigated in the current case.

If the criteria above are met, the APS specialist does the following:

Example

The APS specialist investigated an allegation of self-neglect, and then the client dies, allegedly as a result of abuse that was not previously alleged during the current case.

Documentation When a Client’s Death May Involve New Allegations Against a Perpetrator

The APS specialist follows the steps below when the situation meets both of the following criteria:

  • A client dies during the case.
  • The client’s death may be the result of a new allegation of abuse or neglect by a perpetrator that was not previously alleged or investigated during the current case.

The APS specialist does as follows in IMPACT:

  • Adds the new allegation to the Allegation Detail page.
  • Enters a disposition for the new allegation.
  • Records the date of death on the Person Detail page.
  • Chooses the appropriate Reason for Death on the Person Detail page.
  • Documents all case contacts, as outlined in 9000 Case Contacts.
  • Chooses Client Died as the closure reason on the Case Closure page.

The APS specialist is not required to complete the Risk of Recidivism Assessment or Strengths and Needs Assessment.

11300 Notifying the Office of the Inspector General

APS January 2022

APS notifies the HHSC Office of the Inspector General (OIG) and APS State Office when both of the following apply:

  • A DFPS employee’s actions or inaction may have contributed to a client’s death during an open APS case.
  • At least one of the following is suspected: 
    • Employee misconduct.
    • Violation of law.
    • Violation of DFPS policy.

The APS supervisor or designee does the following:

The district director or designee reviews the form to determine whether the situation meets the criteria for notifying OIG. If it does meet the criteria, the district director or designee emails the completed form to all of the following:

      • Assistant deputy inspector general of internal affairs (at OIG).
      • DFPS Internal Audit.
      • APS Field Operations specialist.

The district director or designee makes sure the notification email and form are documented on the External Documentation page in IMPACT or in OneCase.

11400 Adult Fatality Review Team

APS January 2022

Health and Safety Code §672.002 grants counties the authority to develop adult fatality review teams but does not mandate their formation.

The purpose of this team is to investigate certain types of adult deaths generally identified as unexpected. The team promotes cooperation, communication, and coordination among agencies involved in responding to unexpected deaths.

Composition of the Team

The team is composed of multi-disciplinary and multi-agency representatives (for example, law enforcement, criminal prosecutor, medical examiner, and so on) and has certain investigative powers by law. APS is sometimes involved in the review process as a team member, expert witness, or consultant.

Request for Information

A review team requests information and records about adult deaths resulting from suicide, family violence, or abuse, as necessary to carry out its purpose and duties. The team is authorized by law to request and receive case records from APS. APS releases case records to the adult fatality review team without any de-identification.

Health and Safety Code §672.005

Confidentiality of Information

Information and records acquired by the review team in the exercise of its purpose and duties are confidential and exempt from disclosure under the open records law (Chapter 552 of the Government Code). A review team member commits an offense if he or she discloses information restricted to the team to another source.

A team member may make a public statement about the general purpose or nature of the review process for unexpected adult deaths if the statement is not specific to a case.

Health and Safety Code §672.009

Referral to the Adult Fatality Review Team

If a client dies under unusual circumstances, the APS specialist does the following:

  • Determines whether an adult fatality review team exists in the county where the client died.
  • Follows regional procedures for the following:
    • Determining whether a referral is appropriate.
    • Submitting the case to the adult fatality review team, if appropriate.

See 11000 Death of a Client.

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