Weiss EM, et al. Deadly restraint: a Hartford Courant investigative report.
Hartford Courant 1998; October 11 15.
October 11, 1998
Type: SERIES; SIDEBAR
The death of 11-year-old Andrew McClain in a Connecticut psychiatric hospital in March prompted a team of Hartford Courant reporters and researchers to investigate the use of restraints and seclusion.
The investigation began in May and concluded five months later. The team ultimately pored through thousands of pages of policy reports and academic studies, traveled to 10 states, surveyed federal databases and electronic news archives, and spoke to hundreds of regulators, industry officials, analysts, workers and patients. As its first step, the reporting team conducted a 50-state survey to document deaths that occurred during or shortly after restraint or seclusion. The team concentrated on the period from 1988 to the present.
The reporters contacted officials in health care and licensing agencies, child fatality review boards and patient advocates in each state. In most states, many more calls were made to public officials and others.
As part of its investigation, the team compiled a database of 142 patient deaths in psychiatric hospitals, psychiatric wards of general hospitals, group homes and residential facilities for troubled youths, and mental retardation centers and group homes.
Deaths that were confirmed and fact-checked by Courant researchers were compiled in a database now available on our Internet site at www.courant.com. [No longer offered without charge.]
Throughout the reporting, though, it became clear that many deaths go unreported.
For example, only New York state requires the reporting and investigation of every death in a private or state facility to an independent state agency. New York found that 64 people died during or shortly after restraint or seclusion in targeted institutions from 1988 through 1997.
In contrast, only 12 confirmed cases could be uncovered in California in the same period -- because the state simply does not collect the data.
"I hope [your story] doesn't reflect that these are the only deaths in California,'' said Colette Hughes, the state's top abuse investigator for a patient advocacy group. ``There is no doubt that this is the tip of a huge iceberg.'' To better determine the national death rate, The Courant hired statistician Roberta J. Glass. Glass is a research specialist for the Harvard Center for Risk Analysis at the Harvard School of Public Health. She has 14 years' experience in the field of statistical projections.
In her projection, Glass used data from the state of New York, the U.S. Department of Health and Human Services and earlier academic studies on restraint use, among other sources.
If facilities throughout the rest of the country used restraints as often as those in New York state, Glass found, there would be 50 deaths annually nationwide.
But Glass noted the rest of the country was not necessarily like New York state. New York monitors restraint use more closely, and facilities in New York use restraints at a lower rate than national surveys have found elsewhere in the country.
Thus, Glass projected the annual number of deaths could range as high as 150.
"Admittedly, the estimates are only rough approximations,'' Glass said. "The data needed for precise estimation are not collected in a systematic way nationwide.
"But it is clear that greater attention should be paid to this issue, especially in light of the fact that it affects a particularly vulnerable patient population.''
Deadly Restraint Series Staff:
Project reporters: Eric M. Weiss, Dave Altimari, Dwight F. Blint and Kathleen Megan.
Additional reporting: John Springer, Colin Poitras and Hillary Waldman.
Photographers: Rick Hartford, Michael Kodas, Rich Messina, and Michael McAndrews.
Project researchers: Jerry LePore and Sandy Mehlhorn.
"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
Hartford Courant DECEMBER 16th-published Related Article:
USE OF IMPROPER RESTRAINTS WIDESPREAD, GROUPS SAY