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Representatives Degette And Stark Plan Press Conference To Introduce Legislation Ending The Inappropriate Use Of Restraint

Representatives Diana DeGette (D-CO) and Pete Stark (D-CA) are organizing a press conference to announce the introduction of The Patient’s Freedom from Restraint Act of 1999, legislation addressing the inexcusable large number of patients deaths due to restraint, especially occurring to people with serious brain disorders. The press conference will take place on March 25, 11:30 a.m. (place yet to be determined) and Senators Joseph Lieberman (D-CT) and Christopher Dodd (D-CT), who are lead sponsors in the Senate working on the Senate version of the bill, are expected to participate. NAMI has worked diligently with these lawmakers asking for federal legislation to put an end to a needless outcome, death by restraint.

ACTION REQUESTED

All NAMI members and advocates are encouraged to contact this week their Representative in the U.S. House of Representatives and urge them to cosponsor The Patient Freedom from Restraint Act and end the needless deaths of people with serious brain disorders who are being restrained improperly in mental healthcare facilities. A list of current cosponsors appears immediately following this paragraph. If your Representative appears on this list, NAMI members and advocates are urged to thank your Representative for cosponsoring this legislation. U.S. Representatives can be reached through the Capitol Switchboard at 202-224-3121. Email and mail addresses for Representatives can be obtained by going to the policy page of the NAMI website at www.nami.org and click on "Write to Congress."

LIST OF COSPONSORS

Diana Degette (D-CO), Pete Stark (D-CA), Rosa DeLauro (D-CT), Connie Morella (R-MD), Henry Waxman (D-CA), Carolyn Kilpatrick (D-MI), George Miller (D-CA), Sherrod Brown (D-OH), Bernie Sanders (I-VT), Tom Lantos (D-CA), Matthew Martinez (D-CA), Eddie Bernice Johnson (D-TX), Charles Rangel (D-NY), Joe Crowley (D-NY), Lois Capps (D-CA), Nancy Pelosi (D-CA), Harold Ford (D-TN), Jim McGovern (D-MA), Albert Wynn (D-MD), Jan Schakowsky (D-IL).

BACKGROUND

The Patient Freedom from Restraint Act is intended to end the inappropriate use of restraint, document the extent of the problem, raise the requirements for staff training, and allow sanctions for violations of the proper use of restraint. The bill limits the conditions under which restraint and seclusion may be used with patients in psychiatric treatment facilities, facilities for the developmentally disabled, residential treatment facilities for children and similar facilities that receive Medicare and/or Medicaid. To accomplish this, the bill would do the following:

• Establish guidelines for the appropriate use of restraints and seclusion similar to the guidelines from the Nursing Home Reform Act which states, "Restraints and seclusion are only to be used to ensure the immediate physical safety of the patient or others upon the written order of a physician."

• The bill sets up reporting requirements which instruct facilities to maintain a record of the use a restraints within patient records and are open to inspection by Protection and Advocacy systems, report sentinel events (such as patient deaths), make periodic reports on the frequency of use of restraint and seclusion, and compile an annual report on the frequency of restraint use and the number of sentinel events due to restraint use.

• Require facilities to provide annual training of mental health staff on appropriate use of restraints and alternatives.

• Establish guidelines for the use of utilization and quality control peer review organizations to review facilities policies and procedures.

• Monetary sanctions and loss of federal dollars when facilities fail to comply with the provisions in this bill.

DEAR COLLEAGUE LETTERS

Below are two Dear Colleague letters signed by Representatives DeGette, Stark, and Rosa DeLauro (D-CT) urging their colleagues to cosponsor this much needed legislation.

January 15, 1999

As many as 150 people die each
year due to the use of restraint . . .
. . . many are children.

Dear Colleague:

Imagine that you admitted your child with mental disabilities into a psychiatric hospital. You trusted your child would receive the best care. One day you get a call that your child is dead. She died at the hands of the staff paid to take care of her. That is precisely what happened to Edith, Robert and Dustin.

According to an investigative report by the Hartford Courant, 142 people died over a ten year period because of inappropriate use of restraints. Tragically, the actual number of deaths is estimated to be much higher, from 50 to 150 a year. Unfortunately because reporting requirements currently do not exist, there is no way to know just how many of these heartbreaking deaths are ocurring. What we do know is that all of these are completely avoidable.

We can stop the death of some of our most vulnerable Americans by passing the "Patient Freedom from Restraint Act of 1999" which establishes standards for using restraint only in emergency situations under the oversight of a physician. This bill also requires deaths to be reported so that we can measure the extent of this problem and respond appropriately. We urge you to join us in putting an end to this tragic situation by signing onto this important legislation.

Sincerely,

Diana DeGette Pete Stark Rosa DeLauro
Member of Congress Member of Congress Member of Congress

Research Shows Inappropriate Use of
Restraint is a Significant Problem

March 1, 1999

Dear Colleague:

In the past few weeks, we have highlighted a few of the hundreds of egregious and wrenching stories of the harm caused by inappropriate use of restraints in mental health facilities. In addition to these individual stories, research from a number of sources confirms the problems with inappropriate restraint use.

Consider the following findings:

• High death rate. The FDA estimates that hundreds of restraint-related deaths occur each year. To respond to this high rate of associated mortality, the FDA provided new recommendations about the appropriate use of restraint devices in 1992. According to statistics by a Harvard research specialist, deaths due to inappropriate restraint use are anywhere from 50 to 150 each year.

• Better alternatives. According to an FDA report, there is no reliable data to prove that patients who are restrained are safer than those who are not. Many nursing homes have found that small environmental changes like safer chairs, putting a mattress on the floor, and safer floor material, can be more effective at saving lives than using restraints.

• Restraints are counter intuitive to promoting mental health. People going into facilities for mental and developmental disabilities need understanding, emotional support, and therapeutic assistance. Restraint and seclusion can ruin any hope for improvement or recovery. According to research by psychiatrists, 94% of children who were restrained or secluded in a hospital, experienced further trauma.

• No adequate federal response. According to a 1999 CRS report, "there is no one federal statute that sets forth detailed requirements on the use of restraints in mental health care facilities. Federal coverage is piecemeal and uncertain".

• Need for stronger federal oversight. According to a 1996 GAO report on institutions for the mentally retarded, one of the most common problems of deficient care was excessive or inappropriate use of restraints. This report documented how federal oversight was failing due to lack of effective enforcement mechanisms and the decline of direct federal monitoring. The GAO concluded that federal oversight for the mentally retarded should be strengthened.

Clearly the need to protect patients from the inappropriate use of restraint is long overdue. That is why we are introducing the "Patient Freedom from Restraint Act of 1999". We urge you to support this legislation.

Sincerely,

Diana DeGette Pete Stark Rosa DeLauro
Member of Congress Member of Congress Member of Congress

NAMI POSITION ON SECLUSION AND RESTRAINT

The following are the NAMI Public Policy Platform position statements approved by the NAMI Board of Directors on the use of restraints and seclusion.

7.8 Use of Restraints and Seclusion

(7.8.1) The use of involuntary mechanical or human restraints or involuntary seclusion is only justified as an emergency safety measure in response to imminent danger to one's self or others. These extreme measures can be justified only so long as, and to the extent that, the individual cannot commit to the safety of themselves and others.

(7.8.2) Restraint and seclusion have no therapeutic value. They should never be used to "educate patients about socially acceptable behavior;" for purposes of punishment, discipline, retaliation, coercion, and convenience; or to prevent the disruption of the therapeutic milieu.

(7.8.3) Restraints shall be used only with a physician's order and only for emergency safety use. In emergency situations, a RN may initiate the use of restraints for the protection of the patient and/or others. Immediately the physician on duty/on-call shall be contacted and a verbal order must be obtained. The physician involved shall see the patient within thirty(30) minutes of the initiation of the restraints and document his/her assessment of the patient in the medical record. Orders shall specify up to one hour. Specific behavioral criteria written by the physician, including the patient's proclamation of safety, shall specify when the restraints will be discontinued, to ensure minimum usage. When a physician's order has expired, the patient must be seen by a physician and his/her assessment of the patient fully documented as an emergency safety use before restraints can be reordered. Restraints may only be continued for periods of up to one hour at a time and each renewal must be made by a face-to-face examination by the physician.

(7.8.4) Every restraint must be treated as a sentinel event and a root cause analysis must be generated.

(7.8.5) Following each use of restraints and seclusion, the patient should receive trauma counseling.

(7.8.6) Treating professional must adhere to the patient's advance directive, if there is one.

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