Policy Number: 108
Protection from Retaliation
I. POLICY AND GENERAL STATEMENT
The University of Texas Health Science Center at Houston ("university") is committed to including employees, including student appointees, in the process of ensuring that the university operates in an ethical, honest, and lawful manner. It is therefore the policy of the university to:
- Encourage employees to report, or cause to be reported, and to assist in any investigation by persons authorized or responsible for such matters, known or suspected violations of laws, rules, policies, or regulations, or improper activities; and
- Prohibit unlawful retaliation against employees as a consequence of good faith actions in the reporting of, or the participation in an investigation pertaining to, allegations of wrongdoing.
The purpose of this procedure is to provide requirements and guidelines for the protection of individuals from retaliation for good faith actions in reporting, or participating in an investigation pertaining to, alleged violations of laws, rules, policies, or procedures applicable to the university.
A. Procedures for Reporting Wrongdoing or Retaliation
Designation of Responsible Party for Retaliation Complaints
The Chief Compliance Officer shall be the responsible party for the oversight of the implementation of this procedure.
Designation of Responsibility to Report Allegations of Retaliation
It is the responsibility of all individuals who are employed by the university to make a good-faith report of any activity that appears to be in violation of any state or federal law or regulation, The University of Texas System regulation or policy, university regulation or policy, and/or the university Standards of Conduct, including this procedure. A good-faith report is an allegation made with the honest belief that the activity reported may have occurred. An allegation is not in good faith if it is made with reckless disregard for or willful ignorance of facts that would disprove the allegation. Persons making disclosures with reckless disregard for the truth or in willful ignorance of the facts may be subjected to disciplinary action, including termination of employment.
Submitting a Retaliation Complaint
A complaint alleging retaliation must be submitted in writing to the Office of Institutional Compliance. The complaint must contain the following information (the “mandatory information”):
- Name of the complainant;
- Contact information, including address, telephone, and e-mail address, if applicable;
- Name of the person directly responsible for the alleged retaliation;
- Date and place of the alleged retaliation;
- Nature of the alleged retaliation;
- Detailed description of the specific conduct that is alleged to constitute retaliation;
- Copies of any documents pertaining to the alleged retaliation;
- Names of any witnesses to the alleged retaliation;
- Corrective action requested by the complainant;
- Complainant's signature and date of filing; and,
- Any other relevant information.
The following communications do not constitute a retaliation complaint and will not be investigated or resolved pursuant to this retaliation complaint resolution process:
- Oral allegations;
- Anonymous communications;
- Courtesy copies of correspondence or a complaint filed with others;
- Inquiries that seek advice or information only; and,
- Pre-complaint consultations and informal resolution activities.
A written complaint must be filed within thirty (30) calendar days of the occurrence of the alleged retaliation.
B. Procedures for Investigating Reports of Wrongdoing or Retaliation
Acknowledgement and Notification of Receipt of Complaint
Complainant. The Office of Institutional Compliance will send the complainant a brief acknowledgment of the complaint, stating that the complaint will be evaluated, and advising the complainant that he or she will be contacted within a given time. The acknowledgment letter will include a copy of these Procedures for the Handling of an Allegation of Retaliation. The complainant will be kept apprised of the status of the investigation of the matter, to the extent the Office of Institutional Compliance determines the communication does not compromise the integrity of the investigation. If the Office of Institutional Compliance determines that communicating certain information to the complainant would compromise the integrity of the investigation, complete, detailed information on the nature of the investigation may not be provided.
Department Head. After receipt of a written retaliation complaint, the Office of Institutional Compliance shall inform the department head of the allegation. The Office of Institutional Compliance also shall keep the unit head apprised of the status of the investigation of the matter. If the department head is the subject of the investigation, however, then the Office of Institutional Compliance shall provide such information instead to that individual’s supervisor.
Respondent. The Office of Institutional Compliance shall inform the individual against whom the allegations are raised (the “respondent”) of the nature of the allegations and of the status of the investigation at the point and to the extent that the Office of Institutional Compliance determines that it will not compromise the integrity of the investigation.
The Office of Institutional Compliance will initiate an investigation if the written, signed complaint contains all of the mandatory information and is timely, within the scope of this procedure, and states sufficient specific facts, which, if determined to be true, would support a finding that the non-retaliation provisions of the university HOOP were violated. Notwithstanding that the complaint meets the foregoing requirements, the Office of Institutional Compliance may determine not to proceed with a complaint investigation for any one of the following reasons:
- the complainant withdraws the complaint;
- corrective action has been taken, or has been offered and rejected;
- another complaint resolution process is more appropriate; or,
- litigation or another complaint process is pending.
If the Office of Institutional Compliance determines not to proceed with a complaint investigation, it will send a notification letter to the complainant stating the reason for that determination.
Investigative Process and Findings
If it is determined that the university will proceed with a retaliation complaint investigation, the Office of Institutional Compliance or its designee will interview the complainant, the respondent, and any other persons whom the investigator determines may have pertinent factual information related to the retaliation complaint. The investigator shall also gather and examine relevant documents. Facts will be considered on the basis of what is reasonable to persons of ordinary sensitivity and not on the basis of a particular sensitivity or reaction of an individual. Findings will be based on the totality of circumstances surrounding the alleged retaliation.
During the retaliation complaint investigation process, the complainant and the respondent will provide the Office of Institutional Compliance or designee with all documents relied upon regarding the issues raised in the complaint.
Report of Findings and Recommendation; Final Determination
The investigator will provide a proposed statement of findings, copies of relevant documents, and relevant physical evidence to the Chief Compliance Officer within thirty (30) working days of receipt of the respondent's statement, unless unusual circumstances require more time. The Chief Compliance Officer or designee and the investigator shall meet within ten (10) working days thereafter to discuss the findings.
Within fifteen (15) working days after that meeting, the Chief Compliance Officer or designee shall take one of the following actions:
a. Request further investigation into the complaint;
b. Dismiss the complaint; or,
c. Find that the non-retaliation provisions of this procedure were violated, in which event the Chief Compliance Officer or designee, following consultation with the investigator or other knowledgeable persons as appropriate, shall determine disciplinary or corrective actions to be taken.
The Chief Compliance Officer or designee shall notify in writing the complainant, respondent, and appropriate department head of his or her decision. The Office of Institutional Compliance shall retain copies of the Chief Compliance Officer’s letter, the statement of findings, and relevant documents in accordance with the university’s records retention schedule.
Institutionally significant reports, as deemed such by the Chief Compliance Officer, shall be brought to the attention of the Institutional Compliance Committee.
Substitution of Officers
If a retaliation complaint is directed against an official who would otherwise act on the complaint, the function assigned to that official in this procedure will be delegated by the Chief Compliance Officer or the President of the university, as appropriate, to another person.
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