Wednesday, December 17, 2008

Restraint and Seclusion - A Risk Management Guide (2006)

Below is a link to a Risk Management Guide for Restraint and Seclusion. This information primarily concerns mental health facilities, but the principles could also apply to other settings:

Topics in this guide include:

* Restraint and Seclusion Use in Mental Health Facilities is Under Intense Focus

* Many Factors Contribute to the Substantial Legal Risks Associated with the Use of Restraint and Seclusion

* Overview of Legal Claims and Liability Risks Associated with the Use of Restraint and Seclusion

*Effective Tools to Reduce Restraint and Seclusion are Well-Established and Inexpensive

*Action Steps for Attorneys as Risk Managers

Following is an excerpt:

Over the past decade, however, a clear consensus has emerged that restraint and seclusion are safety interventions of last resort and that the use of these interventions can and should be reduced significantly. In evaluating the potential legal risks associated with the use of restraint and seclusion, risk managers should understand this emerging consensus as critical to a determination about whether a particular use of these interventions reflects “the exercise of professional judgment.” This should be considered in the context of the following factors:

(1) Each use of restraint or seclusion poses an inherent danger, both physical and psychological, to the individual who is subject to the interventions and, frequently, to the staff who administer them.

(2) The decision to use restraint or seclusion nearly always is arbitrary, idiosyncratic, and generally avoidable.

(3) Many inexpensive and effective alternatives to restraint and seclusion have been developed and successfully implemented across a broad range of mental health facility types.

The legal consequences of inappropriate use of restraint and seclusion can include civil damages, administrative sanctions (including the loss of Medicaid and Medicare certification), and criminal prosecution. Moreover, litigation about these practices invariably consumes the facility’s attention and resources, no matter what the ultimate outcome, with significant negative implications for the facility’s reputation and staff morale.

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