Legislators call for a ban on seclusion rooms and restraint use on schoolchildren, but CCHR says it must extend to all physical and chemical restraint use in psychiatric facilities, as children are assaulted and die.

By Jan Eastgate
President CCHR International
The Mental Health Industry Watchdog
January 28, 2020

Illinois lawmakers have called for a nationwide ban on the use of seclusion and physical restraints on students. The lawmakers are two U.S. senators and 10 members of the House of Representatives, all but one are from Illinois. They’ve asked Secretary of Education Betsy DeVos to issue federal guidance to prohibit physical restraints for dealing with challenging behavior.  This followed a Chicago Tribune-ProPublica Illinois investigation that found public schools put children in seclusion that violated the law. Most of the children who were secluded had intellectual or behavioral disabilities. Reporters also found that school employees were physically restraining children—sometimes face down on the floor—when there was not an emergency safety risk.[1]

The situation is grave and the ban is necessary; however, why is this is limited to schools, when teens across the country are being restrained in behavioral facilities, being assaulted or abused by staff and have even died from restraints. Add to this, the chemical restraint of students in schools and behavioral facilities with psychotropic drugs and there is a need for a massive investigation into the state of behavioral “care” for children and teens.

As far back as 2002, Charles G. Curie, former administrator of the U.S. Substance Abuse and Mental Health Services Administration called for the elimination of both restraints and seclusion in psychiatric hospitals and stated: “Seclusion and restraint – with their inherent physical force, chemical or physical bodily immobilization and isolation – do not alleviate human suffering. They do not change behavior…. They can serve to re-traumatize people who already have had far too much trauma in their lives.”

This followed a series of articles by The Hartford Courant that found up to 150 restraint deaths occurred each year in the U.S, of which nearly 10% were children, some as young as six.[2]

One of them was 16-year-old Roshelle Clayborne while at the Laurel Ridge psychiatric treatment center in Texas, now owned by a subsidiary of Universal Health Services (UHS). Slammed face-down on the floor, a mental health aide yanked Roshelle’s arms across her chest and gripped her wrists from behind her. “I can’t breathe,” she pleaded. She became suddenly still, blood trickled from the corner of her mouth as she lost control of her bodily functions. Her limp body was rolled into a blanket and dumped in a seclusion room. No one watched her die, the Courant reported.[3]

In April 1999, a Federal Hearing was held into the “alarming number of deaths resulting from physical restraints in psychiatric facilities. It is impossible to say how many there are because there is no requirement for reporting of deaths from physical restraints, in a field which is largely left unregulated.” The Hearing heard that 33% of the victims that died from restraint had been suffocated. More than 26% of those killed were children under 17, a rate that was nearly twice the proportion of that age category in mental health institutions.[4] A U.S. government report “found conclusively that children are especially targeted by facility staff for this unsafe practice (restraints), and are at greater risk of injury and death.” [5] Reports also suggested that 37.5% of child or adolescent inpatients may be secluded or restrained in some manner in psychiatric settings.[6] Further, the potential for adverse effects during restraint can increase for patients receiving psychotropic or other drugs as well as street drugs.[7]

Federal regulations were passed that were to restrict the use of physical and chemical (mind-altering drug) restraints to discipline patients in hospitals receiving federal funding. The regulations also ordered a “national reporting system” to be implemented and for government funding to be cut to any facility that did not comply.[8] A Rule by the Health Care Finance Administration on 22 January 2001 noted that a General Accounting Office (GAO) report had “specifically recommended that we mandate that any hospital or residential facility that treats persons with mental illness or mental retardation, as a requirement for receiving Medicare and Medicaid funds, report promptly to the State licensing body and the appropriate State Protection and Advocacy (P&A) system, all patient deaths and serious injuries among persons with mental illness or mental retardation, and to indicate whether restraint or seclusion was used during or immediately prior to the death or injury.”[9]

Little good this has done and with the lack of oversight of psychiatric facilities—especially in the for-profit/private area—there has been continuing use of violent restraints with children dying. Yet now, there is a call for a ban on school use only of restraints and seclusion when it should be universal. Any patient death from restraints should also be prosecuted.

In 2010, a report on the adverse effects of restraints showed restraint use was still not being effectively monitored.[10] The Centers for Medicare and Medicaid Services (CMS) database does not include restraint with sedatives and is limited to psychiatric patients in general hospitals and freestanding psychiatric hospitals and, therefore, not for-profit facilities.[11]

With the call now to ban school seclusion and restraint use emanating from Illinois, CCHR said it would behoove the legislators championing this to protect all children, not just students.

In April, 2015, Rock River Academy in Rockford, Illinois closed after the Department of Children and Family Services stopped placing juvenile wards there.[12] From July 2014 through November, the facility had the highest rate of youths manually restrained by staff among the 52 residential treatment centers measured by state authorities—nearly eight times the median for all Illinois facilities.[13]

A sample of but some of the restraint abuses uncovered include:

• 2010: A 16-year-old foster child died after being injected with a sedative and restrained in a SSM Health Care, Louis company-owned psychiatric ward, ruled a homicide. Less than two years earlier, a death at the same hospital had led to a state inquiry that uncovered instances of improperly secluding and restraining patients and failing to report deaths to authorities.[14]

• July 2011: Federal authorities cited UHS’s Millwood Hospital in Denton County, Texas over a 6-year old boy who was physically restrained while placed in seclusion. Video surveillance showed a staff member sitting on the bed with his legs wrapped around the boy while he struggled. Due to the incorrect hold, the boy fell face down and sustained a nasal fracture.[15]

• 2012: A lawsuit was filed against UHS-owned River Oaks Hospital in Louisiana that involved a patient’s death at the facility in July 2009. The boy’s mother alleged her son, Craven, was physically restrained by hospital staff, placed in restraints, shot up with sedatives and had a staff member sitting on his chest. Craven was not breathing, his lips had turned blue and vomit was dripping from his mouth. Upon the discovery of Craven’s condition CPR was utilized unsuccessfully and Craven died.[16]

• 2013: An employee at the UHS-owned Milton Girls Juvenile Residential Facility, Florida, was sentenced to jail after being caught on camera slamming a young girl at the facility into a wall.[17] The same year, a mental health technician with UHS-owned The Vines Hospital in Florida, was charged with felony abuse of a 13-year old resident he twisted the arm of causing a spiral fracture. [18]

• October 2015: Strategic Behavioral Health’s Rock Prairie Behavioral Health got five immediate jeopardy citations that included nurses failing to properly assess patients for medical issues before and after using physical or chemical restraints. Two patients were restrained or put in seclusion without proper explanation. Another patient injured her finger in a seclusion room, requiring six stitches.[19]

• 2016: Federal records indicated that Park Ridge Health hospital in North Carolina, owned by Adventist Health System, restrained psychiatric patients 800 hours out of every 1,000 hours with a restraint rate of more than 800 times the national average.[20]

• 2018: A 15-year old boy died after being restrained at North Spring Behavioral Healthcare in North Virginia, owned by UHS.[21]

• 2017: UHS’s Shadow Mountain Behavioral Health in Oklahoma was investigated by health authorities after children as young as five were separated from their parents and held in dangerous situations. Internal surveillance videos also showed children being repeatedly physically restrained, including a 9-year-old boy that a mental health technician grabbed by the neck, pushed against a wall, then slammed to the ground.[22] The facility has since closed.

• 2019: Acadia’s Lake View behavioral hospital in Peachtree Corners in Georgia came under official scrutiny and there were whistleblowers “coming forward about patients who were attacked, restrained and overmedicated.”[23]

• 2019: A 10-year old boy was held in restraints for an hour at Acadia Healthcare’s now closed Desert Hills psychiatric facility and then injected with and overdosed on the antipsychotic, Haldol.[24] Desert Hills of New Mexico was “shut down amid egregious abuse allegations, multiple lawsuits and losing its certification from state regulators,” according to The Nashville Post.  It cited seven lawsuits against the facility which included excessive use of restraints on children—more than 30 times in 60 days.[25]

• November 2019: Sequel Pomegranate in Columbus, Ohio, owned by Sequel Youth & Family Services, came under scrutiny when video footage showed a nurse attempting to restrain a patient wrapped her left arm around a patient’s neck,” “took the patient to the floor,” “kicked,” and “appeared to strike the patient five times with a closed fist in the face/head region.” The child had sustained a concussion a month prior.[26]

• December 2019: The New York Times reported that Acadia Healthcare’s Piney Ridge Treatment Center in Fayetteville, Arizona was using chemical injections to restrain young people in seclusion, a violation of federal rules.[27] Disability Rights Arkansas alleged that the facility used restraints excessively. “They restrain people left and right… grab them and take them in the time-out room and give them shots,” one unnamed patient said, according to inspectors.[28] In January the facility claimed to have stopped chemical restraint use.[29]

• 2019: UHS and Acadia-owned facilities in the UK also show a pattern of restraint use. UK’s Cygnet Health care, owned by UHS, closed a psychiatric hospital, Whorlton Hall, after the BBC’s Panorama reporters went undercover and filmed staff abusing patients.[xxx] In one restraint, a patient was held on the ground for nearly 10 minutes with the staff member who was restraining him handing out chewing gum to colleagues. A police investigation was launched and 16 staffs were suspended.[31]

• January 2020: It was reported that The Cygnet Health Care-owned Chesterholme hospital in Hexham, England, was temporarily closed after the UK Care Quality Commission (CQC), an oversight agency, inspected it and found a high use of physical restraint at Cygnet hospitals owned by UHS compared to other mental health providers.[32]

Patient restraint, assaults and deaths are occurring across the country in for-profit behavioral facilities—chains of psychiatric hospitals reported to State and Federal legislators and agencies since 2008. Federal regulations have failed to curb these requiring stronger intervention. In summary, State legislatures and Congress need to enact effective and accountable state- and federal-oversight systems, ban the use of physical and chemical restraints and facilities and treating doctors violating this accountable both civilly and criminally.

References:

[1] “Illinois Lawmakers Are Calling for a Nationwide Ban on Isolated Timeouts of Students,” ProPublica Illinois, 15 Jan. 2020, https://www.propublica.org/article/illinois-lawmakers-letter-nationwide-ban-isolated-timeouts-students

[2] “For The Record: 11 Months, 23 Dead,” Hartford Courant, 11 Oct. 1998

[3] Eric M. Weiss, “A Nationwide Pattern of Death,” The Hartford Courant, http://www.courant.com/news/special/restraint/day1.stm

[4] https://www.govinfo.gov/content/pkg/CHRG-106shrg57118/html/CHRG-106shrg57118.htm

[5] https://journals.sagepub.com/doi/pdf/10.1177/070674370304800509

[6] Ibid.

[7] Ibid.

[8] “Medicare and Medicaid Programs; Hospital Conditions of Participation: Patients’ Rights; Interim Final Rule,” Federal Register, Department of Health and Human Services, 2 July 1999,  These bills were incorporated into the enactment of the Children’s Health Act of 2000, which was signed by the President on October 17, 2000, https://www.federalregister.gov/documents/2001/01/22/01-1649/medicaid-program-use-of-restraint-and-seclusion-in-psychiatric-residential-treatment-facilities

[9] https://www.federalregister.gov/documents/2001/01/22/01-1649/medicaid-program-use-of-restraint-and-seclusion-in-psychiatric-residential-treatment-facilities

[10] https://www.crisisprevention.com/Blog/October-2010/Adverse-Effects-Associated-With-Physical-Restraint

[11] “Psych Patients at This Hospital Were Tied Down and Ignored, Records Show,” Vice News, 2 Mar. 2016, https://www.vice.com/en_us/article/mbn54n/psych-patients-at-this-hospital-were-tied-down-and-ignored-records-show

[12] Letter from Dieter Waizenegger, Executive Director of CtW Investments to Mr. John H. Herrell, Lead Independent Director and Chairman of the Audit Committee Universal Health Services, Inc., 8 May 2015, http://ctwinvestmentgroup.com/wp-content/uploads/2015/05/CtW-to-John-Herrell-UHS-5-4-15-final.pdf

[13] “Center for troubled girls will close, cites decision by DCFS,” Chicago Tribune, 28 Jan. 2015, http://www.chicagotribune.com/news/watchdog/rtc/chi-youth-treatment-rock-river-20150128-story.html.

[14] http://www.stltoday.com/news/local/metro/girl-dies-during-restraint-at-an-already-troubled-hospital/article_4a10ccdd-5d08-52bd-bfc5-c435014aa09b.html

[15] “Millwood Hospital Cited for Failing to Provide Safe Environment for Pediatric & Adolescent Patients,” UHS Behind Closed Doors, 28 Jul 2011, http://uhsbehindcloseddoors.org/complaint_type/millwood-hospital-cited-for-failing-to-provide-safe-environment-for-pediatric-adolescent-patients/; http://uhsbehindcloseddoors.org/wp-content/uploads/2014/04/TX-Millwood-Hospital-2011.07.28.pdf.

[16] “River Oaks Hospital sued over restraint death of psychiatric patient,” Louisiana Record, 14 Sept, 2012, https://louisianarecord.com/stories/510582330-river-oaks-hospital-sued-over-restraint-death-of-psychiatric-patient

[17] Kaitlyn Ross, “Local family says they lived health care nightmare,” First Coast News, 2 May 2013, http://www.firstcoastnews.com/story/news/local/2014/01/17/4600179/.

[18] Statement of Deficiencies and Plan of Correction, Florida Agency for Health Care Administration, The Vines, 20 Feb 2013; April Warren, “The Vines Hospital faces challenges,” OcalaStarBanner, 31 Jan 2015, http://www.ocala.com/article/20150131/ARTICLES/150139951?template=printpicart.

[19] “Strategic Behavioral Health’s sanctions in five states,” State Journal, Wisconsin, 8 Apr. 2018, https://madison.com/wsj/news/local/health-med-fit/strategic-behavioral-health-s-sanctions-in-five-states/article_7fcf1fd8-9f0c-546b-be0a-4d353623cd52.html

[20] “Psych Patients at This Hospital Were Tied Down and Ignored, Records Show,” Vice News, 2 Mar. 2016, https://www.vice.com/en_us/article/mbn54n/psych-patients-at-this-hospital-were-tied-down-and-ignored-records-show; ownership https://www.citizen-times.com/story/news/local/2015/09/22/park-ridge-whistleblowers-cause-115m-settlement/72614522/

[21] “‘He didn’t deserve the way he died’: Mother of teen restrained at behavioral health facility speaks out,” The Washington Post, 27 Jan. 2018, https://www.washingtonpost.com/local/public-safety/he-didnt-deserve-the-way-he-died-mother-of-teen-restrained-at-behavioral-health-facility-speaks-out/2018/01/26/92428f5e-fd47-11e7-a46b-a3614530bd87_story.html?utm_term=.622b17ddc49a

[24] Roslind Adams, “Videos Show The Dark Side Of Shadow Mountain Youth Psych Facility,” Buzz Feed News, 11 April 2017, https://www.buzzfeed.com/rosalindadams/shadow-mountain?utm_term=.ynvnN5okY#.kwyRK1wNE

[23] Transcript, WSB-ATL (ABC) 11 Nov. 2019, http://mms.tveyes.com/PlaybackPortal.aspx?SavedEditID=eea773f6-1a00-4d26-87cf-185aa2e5e219 and http://mms.tveyes.com/PlaybackPortal.aspx?SavedEditID=affa655c-9115-41f8-8b6a-edad76dfbee8

[24] “Desert Hills staff used ‘booty juice’ to control children,” KOB4 News, 13 Aug. 2019, https://www.kob.com/albuquerque-news/lawsuit-desert-hills-staff-used-booty-juice-to-control-children/5456440/

[25] Kara Hartnett, “Acadia facility closes amid abuse allegations,” Nashville Post, 5 Apr. 2019, https://www.nashvillepost.com/business/area-stocks/article/21063192/acadia-facility-closes-amid-abuse-allegations

[26] “State threatens to revoke Sequel Pomegranate’s license after staff restrains, hits child,” WBNS 10 News, 8 Nov. 2019, https://www.10tv.com/article/state-threatens-revoke-sequel-pomegranates-license-after-staff-restrains-hits-child-2019-nov

[28] “Records: Arkansas Youth Treatment Center Broke Federal Rules,” The New York Times, 1 Dec 2019, https://www.nytimes.com/aponline/2019/12/01/us/ap-us-youth-center-investigation.html

[28] “Records: Northwest Arkansas child site violated U.S. rules,” Arkansas Democrat-Gazette, 1 Dec. 2019, https://www.arkansasonline.com/news/2019/dec/01/records-child-site-violated-u-s-rules-2/?news

[29] https://www.arkansasonline.com/news/2020/jan/26/repairs-underway-at-treatment-center-20/

[30] “US corporations expand across NHS mental healthcare: One in eight inpatient beds in England provided by American companies,” The Financial Times, 7 Nov. 2019, https://www.ft.com/content/4f428fc8-fefe-11e9-b7bc-f3fa4e77dd47

[31] “Whorlton Hall: Hospital ‘abused’ vulnerable adults,” BBC, 22 May 2019, https://www.bbc.com/news/health-48367071

[32] “‘Inadequate’ hospital in Hexham closes after Care Quality Commission criticism,” HC 16 Jan. 2020, https://www.hexham-courant.co.uk/news/18165693.inadequate-hospital-hexham-closes-care-quality-commission-criticism/