New Rule Seeks to Limit Restraining of Mentally Ill

The Clinton administration announced a new regulation Friday designed to prevent the use of inappropriate chemical and physical restraints on psychiatric patients, characterizing it as a sort of patients’ bill of rights for the mentally ill.

The new rule, which becomes effective in 60 days, was drafted in response to growing reports of abuses, some of which have resulted in deaths of patients, including children. It would apply only to federally funded hospitals, but advocates said they hope to extend the standards to private institutions as well.

The exact scope of the problem is unknown. The National Alliance for the Mentally Ill, a patients’ advocacy group, cites figures from Harvard University’s Center for Risk Analysis, which estimates that between 50 and 150 deaths occur annually from the practice of physically or chemically restraining or secluding hospital patients.

Last fall, a series of articles in the Hartford Courant detailed 142 restraint-related deaths in 30 states over the course of a decade. A third of the victims were suffocated as medical personnel struggled to restrain them, and more than 26% of those who died were children under age 17, according to the reports.

Critics say such practices typically occur for the wrong reasons: coercion, convenience or retaliation. They include incidents in which patients are pinned to the floor, strapped to a bed or injected with tranquilizing drugs.

The alliance said it knows of at least three such deaths in recent years in California, although details are sketchy. One was a November 1998 incident in which a 36-year-old man in Stockton suffered a heart attack after being wrestled to the floor by eight people and bound in leather restraints. Another, in February, involved a 16-year-old girl in a Chula Vista private residential care facility who suffocated after she was put face-down on the floor and restrained by four staff members. A third, which occurred in 1993, involved a man put into seclusion with no bathroom facilities after asking for something to help him sleep, according to the alliance.

The use of restraints is not being curtailed across the board. Experts believe it is acceptable to restrain patients, if done under appropriate medical supervision and by trained personnel, to ensure their own or others’ safety or to perform necessary medical procedures.

The rule, which affects 6,200 hospitals that participate in the Medicaid and Medicare programs, will impose the first financial penalties for documented abuses: It will cut off federal funds to affected institutions.

The new regulation also will create a national reporting system so federal officials can better monitor the problem. Hospitals receiving federal funds will be required to report any death “that results from restraint or from seclusion used for behavior management,” according to the Health Care Financing Administration, which runs the Medicare and Medicaid programs.

The regulation will apply to all participating hospitals, including acute, psychiatric, rehabilitation, long-term, children’s and alcohol-drug hospitals. Similar rules already are in place for federally funded nursing homes and short-term care facilities for the retarded.

“It will ensure that restraints are used rarely and only as a last resort,” Sen. Joseph I. Lieberman (D-Conn.) said during a Capitol Hill news conference where the rule was announced.

Lieberman was joined by Tipper Gore, the wife of Vice President Al Gore. Tipper Gore has campaigned to increase the rights of the mentally ill and recently revealed her own bout with depression.

The new federal rule requires hospitals to provide patients or family members with a formal notice of their rights at the time of admission.