Monday, May 11, 2009

OH: Officials want ban on face-down restraint

COLUMBUS, Ohio - Ohio behavioral services officials want the state to ban a form of restraint blamed for the death of a 17-year-old girl at a Cleveland treatment center last year, according to a report obtained by The Associated Press.

State agencies that oversee homes and treatment centers for troubled or disabled youth and adults want to prohibit the control technique that forces patients to lie face down while being restrained, according to a two-page task force report released in response to a Freedom of Information request.

The report cites overwhelming evidence that the technique carries a high risk of serious injury or death. The only exception is in the case of "an identified overriding medical necessity," the report says.

"There is just not any evidence that we can find anywhere that these restraints are safe," Michael Rench, community services deputy director for the Ohio Department of Mental Retardation and Developmental Disabilities, said in an interview Thursday.

"When you're pushing somebody down on the floor face first and you're putting any weight on the back of them, you're beginning to cause problems with the lungs and other parts of the body," said Rench, who headed the task force.

Rench said other techniques, including other types of holds, are not as risky.

The recommendation will go to Gov. Ted Strickland for his review.

The Cuyahoga County Coroner ruled the Dec. 13 death of Faith Finley a homicide, saying the disruptive girl choked on vomit and suffocated at a church-run treatment center while being held in a face-down position. Parmadale Family Services fired three workers involved in the incident, saying they did not follow the center's policies.

Mental disability agencies in Ohio and other states have already banned the restraint or looked at ways to limit physical restraints, according to a survey by the National Association of State Directors of Developmental Disabilities Services.

Virginia regulations prohibit staff in state disability hospitals from lying on or applying pressure to a patient's chest "while the client is in a prone or supine position." Vermont's disability agency bans restraints in which individuals are lying face down or on the ground. In 2006, the Office of Mental Retardation in neighboring Pennsylvania recommended moving toward the elimination of all restraints.

A 2006 study by Cornell University researchers documented 44 deaths nationally of children who died in treatment facilities because of physical holds or other restraints. But several factors can contribute to such deaths, including applying a restraint in the wrong way or not being aware of a patient's pre-existing medical condition, said Martha Holden, one of the study's co-authors.

Holden is wary of states banning a particular type of position because it can send the message that other restraints are always safe.

"They all have risks," she said. "Our message is to try to emphasize that it is a high-risk intervention regardless of what techniques you use."

Rench said his task force considered that concern.

"We understand that there needs to be a use at times of some sort of a physical restraint," he said. "But we want it done in an appropriate and well-thought out and well-trained manner."


On the Net:

Survey of state disability agencies' approach to restraints:

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