2008: OMHDD Issues "Just Plain Wrong"
Excessive Use of Restraints and Law Enforcement Style Devices on Residents with Developmental Disabilities at The Minnesota Department of Human Services Minnesota Extended Treatment Program (METO) in Cambridge, Minnesota
The Minnesota Extended Treatment Options (METO) is a program operated by Minnesota's Department of Human Service's State Operated Services Division. It is licensed as a 48 bed residential program for persons with developmental disabilities. The program was established after the closure of the Cambridge State Hospital and was designed to serve citizens with developmental disabilities who have some of the most challenging behaviors, including those that may have been involved with the criminal justice system or those who have lost their less restrictive community placement.
In April 2007, the Office of Ombudsman for Mental Health and Developmental Disabilities received a complaint about the use of physical restraints on these citizens with disabilities that included the use of metal, law enforcement style handcuffs. In addition, concern was raised by family members that if they did not authorize the use of such restraints, they or their loved one would be subjected to retaliation.
Over the course of the next year, the Office of Ombudsman conducted a systematic review of the treatment provided at the program as well as the laws, rules and quality assurance mechanisms that were applicable to the facility. The agency interviewed clients, family members, facility staff and management, county social service case managers, experts in the field of developmental disabilities and interested stakeholders to gather information about the program and its practices.
What the Ombudsman found was a program that was established with a good foundation and lofty goals but had slid into a pattern of practice that used restraints as a routine treatment modality in far too many cases. Generally accepted best practice standards indicate that restraints should only be used in a situation where there is imminent risk to the client or others and only for as long as the risk is present. In addition, the use of restraints is a matter of Civil and Human Rights.
Current best practice standards focus on positive behavioral supports, which includes assessing the purpose of the behaviors and finding positive alternatives for the individual to employ. In the course of the review, the Ombudsman found that 63% of the residents who were in METO at the time of the Ombudsman's review had been restrained. Most of those who had been restrained had been restrained multiple times.
One of the most egregious of the cases revealed a client who had been restrained 299 times in 2006 and 230 times in 2007. When the Ombudsman examined what alternatives had been tried to avoid the use of restraints our agency saw that many times no alternatives were attempted. In some cases the length of time the person was in restraints exceeded the facility's own guidelines.
In addition to practices of the facility, the Ombudsman looked at all of the various agencies who had protective obligations for these clients or responsibility to serve as a check and balance over the actions of the program. For a variety of reasons, those checks and balances failed to protect the clients served by the program or turned a blind eye to the problem.
It was not until the Ombudsman's Office started raising red flags that actions to identify and correct the problems began. The Minnesota Office of Health Facility Complaints (OHFC) issued a report with 99 pages of problems and citations. The DHS Licensing Division followed with a report outlining additional rule violations.