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Date: Wed, 31 Mar 1999 13:19:37 -0500

Subject: NAMI E-News    Federal Action Alert - Restraints

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NAMI E-News          March 31, 1999            Vol. 99-109
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FEDERAL ACTION ALERT
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GRASSROOTS ACTION NEEDED TO ENACT PATIENT FREEDOM FROM RESTRAINT LEGISLATION

On March 25, the NAMI E-News reported on the introduction of three bills in
Congress addressing widespread reports on the abuse of restraints and seclusion
on patients with serious brain disorders in psychiatric facilities.  These
reports documented unchecked systemic abuses of the use of physical restraints
that has resulted in an alarming number of consumer deaths.  In October 1998,
The Hartford Courant reported on a 50-state survey conducted by the newspaper
that documented at least 142 deaths in the past decade connected to the use of
physical restraints or to the practice of seclusion.  According to a separate
statistical estimate commissioned by The Courant and conducted by the Harvard
Center for Risk Analysis, between 50 and 150 such deaths occur every year across
the country.  NAMI has recently released a summary of reported incidents since
the publication of the Hartford Courant article which includes five deaths over
the past five months and can be accessed online at the NAMI website,
http://www.***.com/ .

NAMI has worked diligently with lawmakers and allies in the mental health
community to develop legislation that sets national standards that restrict the
use of seclusion and restraints to emergency situations in which physical safety
is at risk and requires the mandatory reporting of deaths and injuries to legal
authorities.  Senators Joseph Lieberman (D-CT) and Christopher Dodd (D-CT) both
introduced individual legislation in the Senate (Lieberman S. 736, and Dodd S.
750) and cosponsored each others bill.  Representatives Diana DeGette (D-CO),
Rosa DeLauro (D-CT) and Pete Stark (D-CA) introduced "The Patient Freedom from
Restraint Act" (H.R. 1313) in the House and currently has 21 cosponsors.

ACTION NEEDED

All NAMI members and advocates are urged to contact their Senators and
Representative and encourage them to support and cosponsor these bills (in the
Senate S. 736 and S. 750, and in the House H.R. 1313) and end the tragic deaths
of consumers in psychiatric facilities from abuse of restraints and seclusion.  
Restraint legislation should provide national standards that only allow the use
of restraints for physical safety and mandate reporting of deaths and injuries.
All members of Congress can be reached through the Capitol Switchboard at
202-224-3121.  Fax, email and mail addresses can be obtained by going to the
policy page of the NAMI website at http://www.***.com/ and click on Write to
Congress.

SUMMARY OF LEGISLATION

DeGette-Stark-DeLauro Bill - H.R. 1313

NAMI strongly endorses the legislation introduced (H.R. 1313) by Representatives
Diana DeGette (D-CO), Rosa DeLauro (D-CT), and Pete Stark (D-CA).

"The Patient Freedom From Restraint Act" represents the strongest and most
protective approach being proposed. The legislation:

recognizes that restraints never should be considered part of therapeutic
treatment, but rather used only in emergency responses, which can only be
justified if physical safety is at risk;

requires consistency in the regulation of restraints for all Medicare and
Medicaid facilities that provide treatment to persons with psychiatric
illnesses;

requires mandatory reporting of deaths and serious injuries to a legal
authority in each state;

enacts "best practice" standards; and

includes strong sanctions.

H.R. 1313 currently has 21 cosponsors:

Stark (D-CA), Morella (R-MD), Kilpatrick (D-MI), Brown (D-OH), Lantos (D-CA),
Johnson (D-TX), Crowley (D-NY), Pelosi (D-CA), McGovern (D-MA), Schakowsky
(D-IL), Berkley (D-NV), DeLauro (D-CT), Waxman (D-CA), Miller (D-CA), Sanders
(I-VT), Martinez (D-CA), Rangel (D-NY), Capps (D-CA), Ford (D-TN), Wynn (D-MD),
and Cummings (D-MD).

Lieberman Bill - S. 736

Senator Joseph Lieberman (D-CT) introduced legislation (S. 736) co-sponsored by
Senator Christopher Dodd (D-CT) that also establishes a nationally consistent
standard for Medicare and Medicaid facilities, based on recognition that
restraints and seclusion are appropriate only in emergency situations that
involve physical safety.

This legislation also mandates reporting of deaths and serious injuries to
federal and state agencies, and if the facility is accredited, to the industrys
Joint Commission on the Accreditation of Healthcare Organizations (JCAHO).

NAMI regards Senator Liebermans leadership as making a significant, positive
contribution to the issue; however, we are disappointed by some provisions in
the bill.  Its approach allows a facility to determine for itself whether a
death or injury constitutes an "unexpected occurrence" that requires that it be
reported.  Only reports of deaths and injuries that are part of an undefined
"pattern of poor performance" will become public information.  Facility analyses
of deaths also will remain "confidential," denying consumers and families access
to important information.  We hope that these provisions will be modified after
further deliberations but we encourage NAMI members to urge their U.S. Senators
to cosponsor S. 736.

Dodd Bill - S. 750

Senator Christopher Dodd has also introduced legislation (S. 750), co-sponsored
by Senator Lieberman, that would amend the "Protection & Advocacy for Mentally
Ill Individuals  Act" (PAMII) to require the reporting of restraints- and
seclusion-related deaths within seven days.

As a member of the Senate Committee on Health, Education, Labor and Pensions,
which has jurisdiction over PAMII, Senator Dodds leadership will be important
in the legislative process.  His focus on PAMII has the potential to broaden
dimensions of the congressional debate.

The Lieberman and Dodd bills will complement each other and together provide a
foundation for action in the Senate.  NAMI member support for S. 750 is also
encouraged.

NAMIS PLATFORM POSITON ON RESTRAINTS AND SECLUSION

7.8     Use of Restraints and Seclusion

(7.8.1) The use of involuntary mechanical or human restraints or
involuntary seclusion is only justified as an emergency safety measure
in response to imminent danger to one's self or others.  These extreme
measures can be justified only so long as, and to the extent that, the
individual cannot commit to the safety of themselves and others.
(Revised February, 1999)

(7.8.2) Restraint and seclusion have no therapeutic value.  They should
never be used to "educate patients about socially acceptable behavior;"
for purposes of punishment, discipline, retaliation, coercion, and
convenience; or to prevent the disruption of the therapeutic milieu.
(Revised February, 1999)

(7.8.3) Restraints shall be used only with a physician's order and only
for emergency safety use.  In emergency situations, a RN may initiate
the use of restraints for the protection of the patient and/or others.
Immediately the physician on duty/on-call shall be contacted and a
verbal order must be obtained.  The physician involved shall see the
patient within thirty(30) minutes of the initiation of the restraints
and document his/her assessment of the patient in the medical record.
Orders shall specify up to one hour.  Specific behavi{*filter*}criteria
written by the physician, including the patient's proclamation of
safety, shall specify when the restraints will be discontinued, to
ensure minimum usage.  When a physician's order has expired, the patient
must be seen by a physician and his/her assessment of the patient fully
documented as an emergency safety use before restraints can be
reordered.  Restraints may only be continued for periods of up to one
hour at a time and each renewal must be made by a face-to-face
examination by the physician. (Revised February, 1999)

(7.8.4) Every restraint must be treated as a sentinel event and a root
cause analysis must be generated. (Revised February, 1999)

(7.8.5) Following each use of restraints and seclusion, the patient
should receive trauma counseling. (Revised February, 1999)

(7.8.6) Treating professional must adhere to the patient's advance
directive, if there is one. (Revised February, 1999)

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