RESTRAINT

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RESTRAINT SECLUSION REDUCTION AND ELIMINATION
PROJECT
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Florida leads the nation in per capita deaths
related to restraint and seclusion

• Between August 2, 1999 and March 23, 2000, 20
  deaths in restraints were reported nationally to
  CMS.
• 7 were in Florida.
• Florida had at least 4 deaths in restraint in
  2004.
• Florida has had at least 15 deaths in restraint
  and seclusion over the last 8 years.
• The number of deaths in Florida is on the rise.

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The Advocacy Center is currently investigating 9
deaths

• 5 investigations are complete
• Deaths occurred between February, 2004 and
  August, 2005.
• 2 occurred in state mental institutions.
• 3 occurred in state designated private receiving
  facilities.

• All deceased individuals were members of racial
  or ethnic minorities.
• 4 of the 5 involved security guards with varying
  amounts of mental health training.

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• 3 of our completed investigations found
• prone restraint
• airway obstruction
• staff applying weight on back of torso
• 2 deaths involved use of wrist restraints behind
  the back

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• 3 of the individuals had known medical conditions
  which increase the danger of using restraint
• 1 involved use of prone mechanical restraint
• 1 involved use of a risky takedown procedure in
  preparation to utilize a four point prone
  restraint

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Medical Examiner Rulings

• 1 death ruled a homicide due to traumatic
  asphyxia
• 1 death ruled due to positional asphyxia
• 1 death ruled due to acute psychotic reaction and
  injuries sustained during restraint efforts
• 2 still pending

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No single agency in Florida tracks all deaths in
restraints and seclusion

• AHCA receives reports from hospitals licensed
  under Chapter 395 and from private ICFs/DD.
• DCF receives reports from public receiving
  facilities.
• APD receives reports from all DD facilities
  except private ICFs/DD.
• However, the Abuse Registry should receive
  reports of all of the above.

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This is a developmental disabilities problem too

• At least 1 individual with mental retardation
  died in a DD community facility in 2005.
• The Advocacy Centers investigation of this death
  is incomplete.
• However, restraint and seclusion regulations for
  DD community facilities are minimal.

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Investigations of restraint deaths in other
states have resulted in

• Virtual elimination or the banning of the use of
  restraint in the state system
• Facility banning the use of certain kinds of
  restraints, such as prone
• Closure of a facility
• Removal of individuals from a facility
• Appointment of special prosecutor
• State legislatures have studied the use of
  restraints and seclusion
• State legislatures have passed comprehensive
  legislation restricting the use of restraint and
  seclusion

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Advocacy Center Restraint and Seclusion Project
Objectives

• The Advocacy Center is seeking at least 6 major
  changes for individuals with psychiatric and
  developmental disabilities.

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• 1 Establish a single statewide reporting system
  for all restraint/seclusion-related deaths and
  serious injuries for both individuals who are
  restrained and secluded as well as staff members.

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• 2 Create performance measures related to
  restraint/seclusion episodes in state
  institutions, receiving facilities, group homes
  and all other facilities where restraint/seclusion
  takes place. These measures should focus on
  analysis, reduction and ultimately elimination of
  these incidents.

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• 3 Post de-identified data per facility or
  institution on a publicly accessible website for
  all restraint/seclusion related deaths and
  serious injuries for both individuals who are
  restrained and secluded as well as staff members.

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• 4 Create statutory language that will bring
  Florida in compliance with accepted national
  standards for the use of restraint/seclusion
  techniques, as well as increased supervision and
  monitoring of episodes of restraint/seclusion.

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• 5 Standardize and enhance the mandatory training
  of state agency personnel responsible for
  investigating restraint and seclusion deaths and
  serious injuries.

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• 6 Change the culture around the use of
  restraint/ seclusion to one in which the use of
  these actions is viewed as a treatment failure
  and in analyzed as such. It must be understood
  that restraint is not a casual treatment but a
  violent process, with the potential for death to
  occur every time the action is taken.

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Next steps

• The Advocacy Center for Persons with
  Disabilities, Inc. is working with AHCA, DCF,
  APD, as well as providers, to develop bill
  language to address shared concerns.
• The Advocacy Center requests the support of the
  SAMH Corporation upon bill filing.
• For more information contact
• Kathryn R. Dutton-Mitchell
• 800-350-4566
• kathrynd_at_advocacycenter.org