Special Attention: Health quality/restraints

Mr. Chairman, Sen. Harkin, members of the Committee. Thank you for holding this hearing on the deadly use of restraints in mental health facilities, and giving me the opportunity to testify.

Last October, I read with increasing horror and shame, a brilliantly investigated and written series of stories in The Hartford Courant describing 142 deaths that were caused by restraint and seclusion in mental health facilities in our country over the last ten years. In many ways, it was like a trip back into Medieval times, into an existence that otherwise would have been invisible to most of us.

Although their care was federally funded, these victims enjoyed no federal protections - certainly none that were relevant to what was done to them. Even basic information about the number and circumstances of their deaths was difficult for their loved ones to obtain.

So, I come to this hearing today with a sense of anger about the treatment of some of the most vulnerable people in our society and with a determination to work with you and others to prevent future deaths and injuries from the improper - at times barbaric - use of restraints.

Also, I come with a sense of urgency. Just last Friday I learned of yet another young boy who died in a mental health facility in Chesterfield, Virginia, after the use of restraints and seclusion.

The facts certainly seem to warrant the conclusion that restraints and seclusion are cruelly overused in America’s mental health institutions; they are used inhumanely; and too often they are used with fatal results. Allow me to share some of the stark findings from the Courant articles:

– deaths were reported in 30 states including both Pennsylvania and Iowa.
– 33 percent of the victims were suffocated.
– More then 26 percent of those killed were children under 17 - a rate that is nearly twice their proportion in mental health institutions.

Of course, aggregate statistics do not adequately convey the tragedies experienced by families across this country. The victims’ stories would better describe the agony their deaths.

Andrew McLain was 11-years-old when he was crushed to death at a Connecticut hospital while a nurse ate her breakfast nearby.

In Massachusetts, 12-year-old Robert Rollins was suffocated after a dispute over his missing teddy bear.

Nineteen-year-old Melissa Neyman suffocated when staffers at a Washington residential facility strapped her to her bed at 10 p.m. and didn’t check on her until the next morning, when they found her dead entangled in her own restraints.

Edith Campos, 15, was crushed face down at an Arizona youth center. Edith was looking at a family photograph when a male aide instructed her to hand over the “unauthorized” personal item.

Dustin Phelps, 14, died when the owner of an Ohio home wrapped him in a blanket and a mattress and tied it together with straps. Dustin was left in the mattress for four hours.

Shortly, you will hear from Jean Allan who will describe the parental nightmare she experienced - the death by suffocation of her 16-year old son, Tristan Sovern.

As a parent, I extend my sympathy to her and to other parents whose children have died merciless deaths in restraints.

As a Senator, I am express my commitment to work with my colleagues to prevent further tragedies. One of the essential purposes of government surely must be to protect those who cannot protect themselves. We are too late for the children I have named. But if we act quickly and aggressively, we can protect others.

Chairman Specter and Ranking Member Harkin, I applaud your efforts to make sure that the mental health care funded by your Committee does not result in injury or death. You have acted more quickly than any other Committee of Congress to address this national shame and that seems appropriate. Federal funding sources including Medicare, Medicaid, and SAMHSA comprised almost 40% of the $36 billion that flowed into mental health organizations in 1994.

I have introduced legislation with Senator Dodd that would extend existing nursing home standards on the use of restraints to mental health patients and add a reporting requirement for deaths and serious injuries to institutions funded by the Medicare and Medicaid programs. Senator Dodd also has introduced companion legislation for a different funding stream, which I am co-sponsoring. And our Connecticut colleague Rep. Rosa DeLauro and others have introduced a similar bill in the House.

Our bill explicitly forbids the use of restraints unless approved - in writing - by a physician, except under emergency circumstances. In other words, restraints are not to be used for discipline or convenience. This same standard - in effect in nursing homes since 1987 - has reduced the use of restraints by over one third. Our bill would extend those returns to the entire national mental health community. Our bill also requires that facilities report deaths and serious injuries to mental health patients under their care so that the cause of the death or injury can be analyzed , preventative steps developed, and the public alerted. With mandatory reporting under state law, Pennsylvania is already producing dramatic reductions in the use of restraints and seclusion in its state mental hospitals.

I am encouraged by the response to our legislation, which is supported by the National Alliance for the Mentally Ill -- two of whose Connecticut affiliate presidents, Karen Hutchin of Granby, Connecticut, and Jeanne Landry-Harpin of Woodbridge, Connecticut -- played a critical role in helping the Hartford Courant investigate and organize its series last year.

Our proposal also is endorsed by the Joint Commission on Accreditation of Healthcare Organizations, the association which sets standards for the health care industry. The commission specifically supports “the mandatory reporting and disclosure of deaths related to the use of restraints.”

Other supporters include the National Mental Health Association, the National Association of Protection and Advocacy Systems, and the Bazelon Center for Mental Health Law.

We owe The Hartford Courant a debt for breaking through the walls of secrecy that concealed 142 deaths caused by the deadly use of restraints. Your hearing today is the beginning of action by Congress that will tear down that wall and erect in its place a better system of protection for America’s mental health patients.

I applaud your action and thank you for your time.