Feds Finally Issue New Institution Restraint And Seclusion
By Dave Reynolds, Inclusion Daily Express
December 12, 2006
WASHINGTON, DC--The federal government has issued its final rules governing the use of restraints and seclusion on patients in Medicare- and Medicaid-funded hospitals and psychiatric facilities.
The U.S. Centers for Medicare and Medicaid Services published the rules on the 8th of December, seven years after the agency formed a committee to study restraint-related deaths, and eight years after the Hartford Courant ran an important exposé on the restraint-related deaths of adults and children -- as young as 6 years of age -- in institutions housing people with mental illness and developmental disabilities.
The new rules, which go into effect February 6 of next year, include limiting physical restraints and seclusion to four hours for adults, two hours for children and adolescents ages 9 to 17, and one hour for patients younger than 9 years of age; requiring facilities to document why an intervention was needed, along with any attempts to use less restrictive methods, and how the patient responded to the intervention; requiring specialized training in non-physical interventions; and specific requirements regarding how and when restraint-related deaths are reported.
In 1998, the Courant published a series entitled "Deadly Restraint," which revealed that 142 patients across the country had died while or after being improperly restrained from 1988 to 1998. A later investigation by the Inspector General for the Department of Health and Human Services revealed that another 104 patients died between August 1999 and December 2004 in CMS-regulated facilities. That report recommended allowing CMS to impose financial penalties to facilities who do not properly report a restraint death. U.S. Senators Christopher Dodd and Joseph Lieberman, both from Connecticut, had included civil penalties in their original proposal, but penalties failed to make it into the final rules because of pressure from hospital associations, the Courant noted.
Also on Friday, members of Connecticut's Congressional delegation wrote to CMS acting director Leslie Norwalk, calling for the agency to better enforce the rules. Senator Dodd has reportedly said it might be time for lawmakers to revisit the issue of financial penalties.
"CMS Publishes Final Patients' Rights Rule On Use Of Restraints And Seclusion Better" (U.S. Centers for Medicare & Medicaid Services)
"Restraints Rules Get New Scrutiny" (Hartford Courant)
"Deadly Restraint: Hartford Courant Investigative Report" (Hartford Courant)