HB 881
Department of Legislative Services
Maryland General Assembly
2021 Session
FISCAL AND POLICY NOTE
Third Reader - Revised
House Bill 881 (Delegate Valentino-Smith)
Health and Government Operations Finance
Mental Health Facilities - Sexual Abuse and Harassment - Reporting and
Prevention
This bill requires a licensed residential treatment center, a State facility, or a hospital with
a separately identified inpatient psychiatric service to report a complaint of sexual abuse
or sexual harassment of a patient within 24 hours of receiving the complaint. A complaint
must be reported to (1) the Behavioral Health Administration (BHA) and the Office of
Health Care Quality (OHCQ) in the Maryland Department of Health (MDH); (2) the Child
Protective Services unit in the Department of Human Services, if the complaint involves a
minor; and (3) the State designated protection and advocacy system. BHA and OHCQ must
collaborate to develop and implement a uniform system for facilities to report complaints.
OHCQ must enforce specified requirements. MDH must adopt necessary regulations.
Fiscal Summary
State Effect: MDH expenditures increase by at least $85,500 (78% general funds,
22% federal funds) in FY 2022 to hire additional staff to investigate complaints and enforce
the requirements of the bill, as discussed below. Future years reflect annualization and
ongoing operating costs. Federal fund revenues increase accordingly.
(in dollars) FY 2022 FY 2023 FY 2024 FY 2025 FY 2026
FF Revenue $18,800 $22,100 $22,800 $23,600 $24,400
GF Expenditure $66,700 $78,500 $80,800 $83,600 $86,500
FF Expenditure $18,800 $22,100 $22,800 $23,600 $24,400
Net Effect ($66,700) ($78,500) ($80,800) ($83,600) ($86,500)
Note:() = decrease; GF = general funds; FF = federal funds; SF = special funds; - = indeterminate increase; (-) = indeterminate decrease
Local Effect: None.
Small Business Effect: None.
 Analysis
Bill Summary: A licensed residential treatment center, a State facility, or a hospital with
a separately identified inpatient psychiatric service must take specified actions related to
the prevention of sexual abuse and sexual harassment of patients. Among other actions,
such a facility must develop and implement policies and procedures on making and
responding to allegations and complaints of sexual abuse or sexual harassment of patients
and adopt a written protection plan as a part of a patient’s treatment plan, if warranted.
Current Law: As designated in § 10-101 of the Health-General Article, “State facility”
means a facility that is owned or operated by MDH.
As designated in § 19-302 of the Health-General Article, “residential treatment center”
means a psychiatric institution that provides campus-based intensive and extensive
evaluation and treatment of children and adolescents with severe and chronic emotional
disturbances who require a self-contained therapeutic, educational, and recreational
program in a residential setting.
Abuse
In general, “abuse” means cruel or inhumane treatment that causes any physical injury or
any kind of sexual abuse. “Abuse” does not include (1) the performance of an accepted
medical procedure that a physician orders or (2) an action taken by an employee that
complies with applicable State and federal laws and applicable MDH policies on the use
of physical intervention. “Sexual harassment” means intimidation, bullying, or coercion of
a sexual nature or unwelcome sexual advances, requests for sexual favors, and other verbal
or physical conduct of a sexual nature that tends to create a hostile or offensive
environment.
For children younger than age 18, “abuse” means the physical or mental injury that
indicates the child’s health or welfare is harmed or at substantial risk of being harmed by
a (1) parent; (2) family or household member; (3) person who has permanent or temporary
custody of the child; (4) person who has responsibility for supervision of the child; or
(5) person who exercises authority over the child because of their position or occupation.
“Abuse” is also the sexual abuse of a child, whether physical injuries are sustained or not.
“Sexual abuse” of a child can include sex trafficking, sexual molestation, or sexual
exploitation.
Reporting Abuse
Mandatory reporters of child abuse include health practitioners, police officers, educators,
and human service workers who are acting in a professional capacity and who have reason
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to believe that a child has been subjected to abuse or neglect. Mandatory reporters must
notify the local department of social services or the appropriate law enforcement agency.
In general, a person other than a mandatory reporter who has reason to believe that a child
has been subjected to abuse or neglect must notify the local department of social services
or the appropriate law enforcement agency.
Any employee of an inpatient facility or of MDH who receives a complaint of abuse, or
who observes or has reason to believe that abuse has occurred, must promptly report the
alleged abuse to an appropriate law enforcement agency or the administrative head of the
facility. The administrative head of the facility must report the alleged abuse to an
appropriate law enforcement agency. Reports of abuse may be oral or written and must
contain as much information as the reporter is able to provide. A State inpatient facility
under the direction of BHA must report complaints of sexual abuse and sexual harassment
to the State-designated protection and advocacy system.
A law enforcement agency must thoroughly investigate each report of alleged abuse and
attempt to ensure the protection of the alleged victim. The investigation must include
(1) a determination of the nature, extent, and cause of the abuse, if any; (2) the identity of
the alleged abuser; and (3) any other pertinent fact or matter. Within 10 working days after
completing the investigation, a law enforcement agency must submit a written report of its
findings to the State’s Attorney, the State-designated protection and advocacy system, and
the administrative head of the facility.
A person has immunity from liability for (1) making a report; (2) participating in an
investigation arising out of a report; or (3) participating in a judicial proceeding arising out
of a report.
Abuse Prevention
BHA must ensure that State inpatient facilities (1) develop and implement uniform policies
and procedures on making and responding to allegations and complaints of sexual abuse
or sexual harassment; (2) ensure that staff provide assistance to patients who have
requested assistance in making complaints about sexual abuse or sexual harassment;
(3) develop and oversee training for staff on how to identify and prevent sexual abuse and
sexual harassment, how to respond to complaints, and how to support victims in an
appropriate manner; and (4) develop and oversee patient education on identifying sexual
abuse and sexual harassment and on reporting incidents of sexual abuse and sexual
harassment. Each State inpatient facility must:
 use evidence-based screening tools to identify, on admission, a patient’s risk of
being a victim of sexual or physical abuse, or being a sexual or physical abuser,
and consider the assessment of risk in making any unit and room assignment;
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 reassign any patient accused of sexual assault to another unit and ensure that any
alleged victim and the alleged assailant are not housed in the same unit;
 provide a patient who has a history of sexual trauma with treatment and education
that is evidence-based or reflective of best practices to reduce the likelihood of the
patient being the victim of repeated sexual abuse; and
 ensure that designated clinical staff are trained in at least one trauma recovery
modality that is considered to be a best practice.
BHA must develop and implement a plan to secure the sleeping quarters of male and female
patients at all State inpatient facilities that maximizes the use of available resources and
infrastructure.
State Fiscal Effect: MDH advises that hospitals and residential treatment centers currently
report sexual abuse or sexual harassment complaints to the department. MDH further
advises that 38 reports of sexual abuse or harassment were received from 5 State
psychiatric hospitals in calendar 2020. Under the bill, approximately 40 additional
hospitals with a separately identified psychiatric inpatient service must report sexual abuse
or sexual harassment complaints of patient’s to BHA and OHCQ, and OHCQ must enforce
the bill’s requirements for these facilities. Based on the number of reports received from
State facilities, MDH estimates that approximately 240 additional reports will be received
from hospitals annually under the bill. In order to investigate these additional reports and
enforce the bill, OHCQ requires additional staff.
Thus, OHCQ expenditures (78% general funds, 22% federal funds) increase by at least
$85,472 in fiscal 2022, which accounts for the bill’s October 1, 2021 effective date. This
estimate reflects the cost of hiring one health facilities nurse surveyor to investigate these
sexual abuse and harassment complaints and ensure compliance with policies and
procedures. However, to the extent the volume of complaints is greater than anticipated,
additional staff may be needed. The estimate includes a salary, fringe benefits, one-time
start-up costs, and ongoing operating expenses (including travel).
Position 1.0
Salary and Fringe Benefits $74,036
Operating Expenses 11,436
Total FY 2022 State Expenditures $85,472
Future year expenditures reflect a full salary with annual increases and employee turnover
and ongoing operating expenses.
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 Additional Information
Prior Introductions: A similar bill, HB 1558 of 2020, received a hearing in the House
Judiciary Committee, but no further action was taken. Its cross file, SB 818, received a
hearing in the Senate Finance Committee, but no further action was taken.
Designated Cross File: SB 815 (Senator Klausmeier) - Finance.
Information Source(s): Maryland State Department of Education; Department of
Juvenile Services; Department of Legislative Services
Fiscal Note History: First Reader - March 1, 2021
rh/jc Third Reader - April 1, 2021
Revised - Amendment(s) - April 1, 2021
Analysis by: Amberly Holcomb Direct Inquiries to:
(410) 946-5510
(301) 970-5510
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Statutes affected:
Text - First - Mental Health Facilities - Sexual Abuse and Harassment - Reporting and Prevention: 10-101 Health General, 10-701 Health General, 10-705 Health General
Text - Third - Mental Health Facilities - Sexual Abuse and Harassment - Reporting and Prevention: 10-101 Health General, 10-701 Health General, 10-705 Health General