OPA: Restraint and Seclusion

Restraint and Seclusion of Persons with Disabilities
 
INTRODUCTION
 
In the summer of 1998, The Hartford Courant authored a series of articles exposing the injuries and deaths related to the use of physical restraints in Connecticut and nationwide. These articles were inspired by the death of a young man while he was being restrained in a private psychiatric hospital in Connecticut.  The private hospital has since closed.
 
The Connecticut General Assembly took the lead in reviewing current protections against abusive and dangerous use of restraints. The Office of Protection and Advocacy for Persons with Disabilities convened a group of advocates, professionals, family members and persons with psychiatric disabilities in an effort to influence the development of new legal protections.  The ultimate result, P.A. 99-210, “An Act Concerning Physical Restraint of Persons with Disabilities,” was created, passed and signed into law, effective October 1, 1999.  It is now codified into statute and is located at Conn. Gen .Stat. §§ 46a 150-154.
 
Subsequent to the passage of this state statute, a federal statute was enacted providing similar protections for individuals with disabilities.  42 USCA § 290ii.  This statute protects the rights of individuals with disabilities who reside in “Psychiatric Residential Treatment Facilities” (PRFT).  The federal regulation implementing this statute has numerous requirements for the reporting of serious injuries, suicide attempts and deaths, and restriction on the use of restraints and seclusion. 42 C.F.R. § 482.13 This booklet does not provide information on this law or specifically address these protections.   
 
The State of Connecticut also passed a law in 2007 that governs the use of restraint and seclusion in public schools.  Public Act 07-141 is incorporated into Conn. Gen .Stat. §§ 46a 150-154. This booklet also does not address that aspect of the statute.  OPA plans to provide written information on this new law once the regulations are finalized.  This should occur in the fall 2009.
 
This booklet will provide you with answers to basic questions concerning the use of physical restraints, seclusion, and psycho-pharmacologic agents (medications) under state law.  For a copy of the statute you may contact the Office of Protection and Advocacy for Persons with Disabilities at: 860-297-4300(voice), 1-800-842-7303 (toll free, voice/TTY), or 860-297-4380 (TTY) or locate it online through the State of Connecticut website, www.jud.ct.gov
 
Q. Who is protected by this law?
 
Anyone with a disability who is receiving care, education, or supervision in an institution or facility operated by, licensed, or authorized to operate pursuant to a contract with: 
 
• Department of Public Health
• Department of Developmental Services
• Department of Children and Families
• Department of Mental Health and Addiction Services
• Regional Education Services Center such as Capitol Region Education Center (CREC).
 

Q. What is a physical restraint?
 
A physical restraint is any mechanical or personal restriction that immobilizes or reduces the free movement of your arms, legs, or head.  It does not include:

•  briefly holding you to calm or comfort;
•  restraint involving minimum contact necessary to safely
   escort you from one area to another;
•  medical devices/supports prescribed by a health
   care provider to achieve proper body position or balance;
•  helmets or other protective gear used to protect
   you from injuries due to a fall;
•  helmets, mitts, and similar devices used to prevent self injury
   if the device is part of a documented treatment plan
   and is considered the least restrictive alternative.
 
Q. What is a psychopharmacologic agent?
 
Any medication affecting your central nervous system, influencing thinking, emotion, or behavior such as Haldol, Zyprexa, Ritalin, and others.
 
Q. What is seclusion?
 
Your confinement in a room whether alone or with staff supervision so that you are prevented from leaving.  This could be your bedroom or a separate “seclusion/timeout” room.
 
Q. What physical restraints are prohibited?
 
No one may use a “life threatening physical restraint”.  A “life threatening physical restraints” is any physical restraint or hold that restricts the air flow into your lungs whether by chest compression or any other means.
 
In addition, no one may use involuntary physical restraint on you except:

•   as an emergency intervention to prevent immediate or
     imminent injury to you or others; or
•   as long as the seclusion is not used for discipline, convenience
     or as a substitute for a less restrictive alternative.
 
Q.  What types of seclusion are prohibited?
 
No one may place you into involuntary seclusion except :
•   as an emergency intervention to prevent immediate
     or imminent injury to you or others; or
•   as long as the seclusion is not used for discipline, convenience
     or as a substitute for a less restrictive alternative.
 
Q. What medication is prohibited?
 
You may not receive medication without your consent except:
      • as an emergency intervention to prevent immediate
        or imminent injury to yourself or others
                     or
     • if it is a part of your medical, behavioral, or educational
       plan developed consistent with C.G.S. 17a-543
       (Patient’s Bill of Rights)
                    or
     • if no plan has been developed, as part of the initial orders
        of a licensed practitioner.
 
Q. What should be written in my medical/educational record?
 
Your record is required to contain documentation about any use of physical restraint or seclusion.  It should include:

     • a description of the emergency;
     • the nature of the emergency; 
     • other steps, (including attempts at verbal de-escalation)
        taken to prevent the emergency from arising; 
     • a description of the restraint or seclusion, and its duration; and, 
     • its effects on your medical, behavioral, or educational plan.
 

Q. What other protections do I have?
 
   • If you are being physically restrained you must be
      continually monitored by staff. 
   • If you are involuntarily in seclusion you must be
      frequently monitored by staff.  
   • In both situations, you must be regularly evaluated by
      staff for signs of physical distress.  Each evaluation must
      be entered into your record.
 
Q.  Who can I call if I have questions about the use of seclusion, restraint or medications?
 
Office of Protection and Advocacy
for Persons with Disabilities
60B Weston Street - Hartford, CT 06120-1551
860-297-4300; 1-800-842-7303 (toll free CT only);
860-297-4380 (TTY)
 
Department of Public Health
410 Capitol Avenue
Hartford, CT 06106
860-509-7407; 1-800-842-0038 (toll free)
 
Connecticut Legal Rights Project
P.O. Box 351
Silver Street
Middletown, CT 06457
860-262-5030; 1-877-402-2299 (toll free)
 
Statewide Legal Services
425 Main Street, # 2
Middletown, CT 06457
860-344-0380
1-800-453-3320
 

NOTE TO READERS: This information attempts to explain your rights surrounding the issue of physical restraint of persons with disabilities and the provisions of Connecticut General Statutes §§ 46a-150-154. This booklet is not intended to offer substantive legal advice which can only be provided by an attorney.
 
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Content Last Modified on 4/11/2011 10:29:51 AM