[Congressional Record Volume 145, Number 48 (Thursday, March 25, 1999)]
[Extensions of Remarks]
[Page E592]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




     INTRODUCTION OF THE PATIENT FREEDOM FROM RESTRAINT ACT OF 1999

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                        HON. FORTNEY PETE STARK

                             of california

                    in the house of representatives

                        Thursday, March 25, 1999

  Mr. STARK. Mr. Speaker, I am pleased to join with Rep. Degette and 
our colleagues in introducing the Patient Freedom from Restraint Act of 
1999. According to recent estimates, between 50 and 150 people die each 
year in psychiatric hospitals and other residential treatment centers 
while restrained or in seclusion. This legislation would extend much 
needed and long over due protections for people who rely on others for 
their care and safety. Specifically, our legislation will protect 
individuals living in residential facilities for adults and children 
who are developmentally delayed or suffer from a mental health 
disability.
  According to a 1996 GAO report on institutions for the mentally 
retarded, one of the most common problems of care was excessive or 
inappropriate use of restraints. Other reports indicate the deaths due 
to restraint result from inappropriate and reckless use of restraint 
techniques and neglect of the patient's well being. Even if there is no 
physical harm due to restraint, the violent act can have long-term 
implications for the patient's psychological health and recovery.
  Restraint and seclusion have no medical or therapeutic function. In 
fact, these techniques may do more to harm the individual than help. 
The only time that such measures are warranted occur when the person's 
behavior creates an immediate threat to the health and safety of self 
and others.
  Currently, there is no federal statute or uniform regulation that 
protects patients from the misuse of restraints and seclusion. Many 
years ago, the same problem existed in nursing homes. Patients were 
indiscriminately restrained and suffered terrible as a result. The 
Omnibus Budget Reconciliation Act of 1987 greatly changed how the 
nation's elderly are treated. In essence, we revised the Social 
Security Act to make clear that restraint and seclusion could be used 
only in extreme cases. The result of that legislation has been an 
incredible improvement in the treatment that seniors receive. The staff 
of nursing homes found that simple changes in the environment and 
procedures made restraints unnecessary.
  Our legislation would not prohibit the use of restraint or seclusion, 
it merely identifies the conditions when they may be used. The more 
important aspect of the legislation is that it would protect the health 
and safety of the patient. Our legislation would require that treatment 
facilities document the use of restraint and seclusion in the patient's 
treatment or medical record. In addition, to reporting the incident, 
the staff of the facility must document treatment a treatment plan to 
reduce the future risk of episodes requiring restraint or seclusion.
  The legislation would require that residential facilities train their 
staff in the appropriate use of restraint techniques and its 
alternatives. We believe that this is an essential feature of the bill. 
Many of the deaths and severe injuries that patients experience result 
from misuse of standard restraint procedures.
  Finally, the legislation would require that cases of severe injury 
and death be reported to the State's Protection and Advocacy Board, and 
the Secretary of Health and Human Services. Documentation of these 
cases is an essential mechanism for protecting the rights and liberties 
of the patients.

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