Remez M. Use of improper restraints widespread, group says.
Hartford Courant 1998; December 16.
December 16, 1998
By MICHAEL REMEZ; Courant Staff Writer.
Advocates for people with mental illnesses told Sen. Joseph I. Lieberman Tuesday that the use of improper and deadly restraints in mental health facilities is a critical and widespread problem.
The Connecticut Democrat gathered the advocates in his office to discuss strategy for passing legislation to address the problem in 1999. He heard blunt talk that the number of deaths and serious injuries caused by improper restraints is much higher than reported because so many remain undetected. "It is a catastrophe,'' said E. Clarke Ross, deputy director of the National Alliance for the Mentally Ill.
In October, The Courant documented that 142 people died while or shortly after being restrained or secluded in psychiatric hospitals, mental retardation facilities or group homes over the past 10 years.
"We think that's by far the tip of the iceberg,'' said Curtis L. Decker, executive director of the National Association of Protection and Advocacy Systems Inc.
A statistical analysis done for The Courant by a researcher for Harvard Center for Risk Analysis bears that out. That analysis estimated that between 50 and 150 such deaths occur every year across the country.
Lieberman presented the advocates with draft legislation that essentially would extend rules limiting the use of restraints in nursing homes to other facilities. That legislation was initially adopted in 1987.
Joined by Sen. Christopher J. Dodd, D-Conn., and other lawmakers, Lieberman also is asking the investigative arm of Congress, the General Accounting Office, to conduct its own review, compiling independent numbers and looking at uniform policies or protocols that could be put in place.
Lieberman, who will be the top- ranking Democrat on the Senate Government Affairs Committee next year, also plans to ask Sen. Fred Thompson, R-Tenn., the committee chairman, to hold hearings on deadly restraints in the coming months.
The legislation being drafted would add new requirements concerning the use of restraints and seclusion to the Medicare and Medicaid programs that help pay for the private mental health and mental retardation facilities.
Part of Tuesday's discussion amounted to which legislative approach would create the most benefit while engendering the least opposition -- a delicate balancing of policy and politics.
Chris Koyanagi, a lobbyist for the Bazelon Center for Mental Health Law, said nursing home operators objected to the restrictions on restraints when they were first enacted, but have learned to live with them today.
The advocates said Lieberman's proposal is a good starting point, though they seemed eager to make it more expansive. They stressed that some use of restraints is appropriate, but that they must be accompanied by proper training and used only when absolutely necessary, in consultation with medical professionals.
Ross said he hoped any hearings would include people representing facilities that do not use restraints as well as family members of residents of facilities that have been plagued by problems.
Decker said the groups want to work with Lieberman, Dodd and others to propose realistic legislation.
"We want to see results,'' Decker said. "We'll work certainly to make sure we put together something that will pass.''
How the Courant Conducted Its Investigation
"Glossary of Terms" used by the authors
Hartford Courant DEADLY RESTRAINT Investigation DATA BASE
DAY ONE; October 11: A Nationwide Pattern of Death
DAY TWO; October 12: Little Training, Few Standards, Poor Staffing Put Lives At Risk
DAY THREE; October 13: Patients Suffer In A System Without Oversight
DAY FOUR; October 14: People Die And Nothing Is Done
DAY FIVE; October 15: From "Enforcer" To Counselor
Hartford Courant October 17th-published Related Article:
REFORM URGED IN USE OF RESTRAINTS
U.S. LAWMAKERS RESPOND TO REPORT ON DEATHS
Hartford Courant October 24th-published Related Article:
GROUPS CALL FOR REFORM IN USE OF RESTRAINTS
MENTAL HEALTH PROVIDERS REACT TO REPORTS OF 142 DEATHS IN FACILITIES