Federal study found restraints lack
sufficient regulation
By Jonathan Osborne
Sunday, May 18, 2003
In 1999, the U.S. General Accounting Office
issued an disturbing assessment of improper restraints and the way
in which they were — or were not — tracked throughout the country.
The study, which was prompted by a five-part
series on restraint that appeared a year earlier in the Hartford
Courant, found that "only 15 states systematically alert protection
and advocacy agencies about mentally ill or retarded people who have
died as a result of improper restraint or seclusion in residential
treatment settings."
The reports also found that deaths cannot
always be thoroughly investigated because the agencies have had
limited access to medical records, and "fragmentary reporting"
indicates that the death toll may be higher than the 24 deaths the
agency had identified in 1998.
One glaring hole, the report found, is that no
federal regulations govern the use of restraint in psychiatric
hospitals, residential treatment centers for children, or community
group homes. Also, the report reiterated what the Courant had
already reported: Most state regulations do not apply to privately
run facilities.
Not much has changed since the report was
released.
The rules for a federal law passed in 2000 that
would require doctors to check on patients within one hour of a
restraint — now three years later — has not yet been promulgated by
U.S. Secretary of Health and Human Services Tommy Thompson.
Federally funded hospitals have since been
required to report deaths involving restraints. But those rules
still don't cover private facilities.
As a result, no reliable national numbers and
limited state numbers exist to accurately determine how many adults,
much less children, are dying this way either. Conservative
estimates suggest the number of youth dying could be a dozen each
year.
The broken bones, damaged joints and other
injuries sustained by youth while being restrained are not counted.
And still, record keeping that has been left to local agencies is
often incomplete or inaccurate.
For example, older records at the Department of
Protective and Regulatory Services are in such disarray that
officials there could not comply with open records requests from the
American-Statesman and at least one legislator's office because they
say death reports prior to 1998 could not be retrieved or sorted to
show which deaths were restraint-related.
"We're working with a database system that has
been pieced together over the years," explained Geoffrey Wool, the
agency's director of public relations. "Our ability to harvest and
sort through that information continues to evolve along with
technology and as resources are made available to us for that
purpose, we are putting that technology to work."
Still, DPRS doesn't regulate every type of
facility where restraints are used in Texas. And there is no central
system in place that collects such information.
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