Altimari D, Weiss EM.
Reform urged in use of restraints. U.S. lawmakers respond to report on deaths.
Hartford Courant 1998; October 17.
October 17, 1998
By DAVE ALTIMARI and ERIC M. WEISS; Courant Staff Writers.
Members of Connecticut's congressional delegation and a leading advocacy group called for investigation and reform Friday in the wake of a Courant report on the misuse of restraints in psychiatric and mental retardation facilities nationwide.
"I was stunned by the number of deaths,'' said U.S. Sen. Christopher J. Dodd, D-Conn. "Like most people, I never realized the lack of standards, training and policing of psychiatric institutions. We have to adopt some national standards to stop this from happening.'' U.S. Sen. Joseph I. Lieberman, D-Conn., said he will call for congressional hearings in January based on the newspaper's report, which he called "heartbreaking and infuriating.''
"All the deaths are tragic, but it's the children who are in a weaker position that we feel for the most,'' Lieberman said. "These deaths happened in dark spaces that we don't ever see but now must explore.''
Lieberman and Dodd said they have assigned staff to draft proposed legislation.
The Courant reported this week that 142 people died during or shortly after restraint or seclusion nationwide in psychiatric facilities, mental retardation centers and group homes over the past 10 years.
But because many of these cases go unreported, the actual number of deaths during or after restraint is believed to be much higher.
Between 50 and 150 such deaths occur every year across the country, according to a statistical estimate commissioned by The Courant and done by a research specialist at the Harvard Center for Risk Analysis.
The National Alliance for the Mentally Ill called for the U.S. Department of Justice and the U.S. Department of Health and Human Services to launch a ``thorough national investigation to determine the magnitude of abusive and harmful seclusion and restraint practices in psychiatric treatment facilities.''
"Many of the restraints used routinely in these facilities aren't supposed to be used,'' the alliance's executive director, Bill Emmitt, said Friday. "This is a group of people whose rights are being egregiously violated.''
The alliance, the nation's leading advocacy group for the mentally ill, also called for:
* Independent investigations into all deaths in psychiatric institutions.
* A shift in hospital oversight from the existing system, which relies heavily on an industry-funded accreditation group, to a system using independent inspectors.
* National standards on the appropriate use of restraints, and funding to train mental health workers.
Justice Department officials said Friday they could not comment until they have reviewed the alliance's request.
But an official with the nation's hospital association called the alliance's demands an "overreaction.''
"To cast a shadow over every psychiatric hospital and say they're guilty until proven innocent is wrong,'' said Rick Wade, senior vice president of the American Hospital Association.
A top official with the U.S. Center for Mental Health Services -- the federal government's mental health agency -- said he is open to a discussion of the alliance' proposals.
"We're willing to take a hard look at whatever is being discussed, and we'd be glad to sit down and look at NAMI's ideas,'' Dr. Thomas Bornemann said. "Under our current legislation we're unable to track deaths.''
That would change if members of Connecticut's congressional delegation have their way. Lieberman, Dodd and U.S. Rep. Rosa L. DeLauro, D-3rd District, said Friday a national clearinghouse should be established to track restraint-related deaths.
"I'm appalled at the number of deaths,'' DeLauro said. "It's staggering and outrageous, and this is something I will get involved in.''
Lieberman said he plans to ask the General Acounting Office to document and investigate the number of restraint-related deaths across the country and report to Congress.
In its report, The Courant documented 23 deaths nationwide during an 11-month period in 1997 and 1998. The period began with the death of one Connecticut boy, Robert Rollins, and ended with the death of another, Andrew McClain.
The report found many similarities in the cases, including poor training and inadequate emergency response.
For example, Robert and Andrew died in virtually the same restraint hold. The boys were each restrained face down on the floor, with their arms crossed beneath them and a staff member exerting pressure on their backs.
This week, Robert's family contacted DeLauro and Lieberman, asking for a ban on the hold that killed the 12-year-old New Haven boy.
Robert died in April 1997 at the Devereaux School in Rutland, Mass., after he became upset that he couldn't find his favorite teddy bear.
Robert, who weighed less than 90 pounds, was restrained face down on the floor by a social worker even as Robert made ``barking noises'' in a futile struggle to breathe.
His lifeless body was left on the floor while the social worker went to attend to another student. His death was ruled an accident, and no one was arrested.
"Something has to be done to stop these kids from getting killed,'' said Sheila Ford, Robert's aunt.
Lieberman said he hopes to expand nursing home legislation, approved in 1987, that restricted the use of restraints. "For some reason that's not clear to me, psychiatric facilities were excluded from that legislation,'' Lieberman said.
Dodd said solutions also could include national licensing for all mental health aides. Only three states -- California, Colorado and Kansas -- actively license aides.
He said other potential moves -- such as reviewing the effectiveness of the nation's protection and advocacy system, and of its hospital oversight system -- will be studied.
"I want to research to what extent we are involved with funding and provide some federal law so we can stop these deaths,'' Dodd said.
Several candidates for congressional office also pledged their support for reform measures. They included Gary Franks, Dodd's Republican opponent; Kevin O'Connor and John Larson, candidates in the 1st Congressional District; and Martin Reust, the Republican candidate in the 3rd District.
"We need to find out the magnitude of [the problem] and, if it is happening, we need to address it immediately,'' Franks said. "Getting an independent third party to look into these facilities with unannounced visits seems to be a good move as well.''
Calls for action
* Congressional hearings sought. U.S. Sen. Joseph Lieberman said he will call for congressional hearings on the misuse of restraints.
* Legislation being drafted. Lieberman and U.S. Sen. Christopher Dodd said they are researching reform legislation such as nationwide licensing of mental health aides.
* A call for a federal investigation. The country's leading advocacy group for the mentally ill has asked the U.S. Justice Department and the Department of Health and Human Services to investigate restraint abuses nationwide.
* Proposals to document deaths. Members of the state's congressional delegation called for a national effort to track all restraint- related 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
Hartford Courant DECEMBER 16th-published Related Article:
USE OF IMPROPER RESTRAINTS WIDESPREAD, GROUPS SAY
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