RESTRAINTS: Federal Legislation Aims to Fill Regulatory Void
Federal legislation regulating the use of physical restraints on mental health patients is on the verge of introduction, largely in response to a Hartford Courant series that exposed many abuses. The Courant reports that bill sponsor Sen. Joseph Lieberman (D-CT) said, "The evidence compiled is so overwhelming and the issues are of life-and-death [importance]. Unless someone can come up with an argument that I haven't heard of, I expect bipartisan support." Rep. Diana DeGette (D-CO), co-author of the House bill with Rep. Pete Stark (D-CA), said, "What really pains me is that a disproportionate number of those who died from restraints are children." The DeGette-Starks bill would "create specific and detailed federal guidelines on restraint and seclusion use in mental health facilities," as well as "track the use of restraint and seclusion nationwide and require all deaths to be reported to independent, federally funded agencies in each state." Stark said, "As for-profit hospitals care more and more about the bottom line and less and less about patient care, the incidents of unsafe care are increasing."
Although the use of restraints is regulated in nursing homes under a landmark 1987 reform bill, mental health facilities are not required to report deaths from restraints. Curtis Decker, executive director of a coalition of advocacy groups in favor of the bill, said, "We don't want to give facilities the wiggle room to pick and choose what deaths to report." The industry largely opposes the legislation, preferring instead to study the problem and produce voluntary guidelines. American Psychiatric Association Medical Director Dr. Steve Mirin said, "We think legislation should grow out of the understanding of the problem, instead of preceding it with a whole host of regulatory changes." Stark responded, "Regulation is considered a bad word mostly by people who are providing poor quality care or harming people" (Weiss/Altimari, 1/31).