Restraints' use is to be focus of review

Restraints' use is to be focus of review

Use of physical restraints for people with disabilities in two state facilities will be the subject of an external review. An initial report to federal court officials is due in mid-March. 

That’s the takeaway from a U.S. District Court ruling issued December 17 in St. Paul. Judge Donovan Frank made the ruling as part of the ongoing Jensen versus Minnesota Department of Human Services (DHS) case. 

The case involved about 300 Minnesotans with developmental disabilities, who allegedly had been mistreated while at the Minnesota Extended Treatment Options (METO) facility in Cambridge. The case was filed in 2009 and a key settlement reached in 2011. 

The case jump-started work on Minnesotan’s federally mandated Olmstead Plan. The plan calls for full community inclusion for people with disabilities. 

Since 2011 the court has monitored various aspects of the state’s programs for people with disabilities and has kept the Olmstead Plan work and other aspects of the settlement under its jurisdiction. 

How state facilities use restraints and positive supports to modify behavior is the focus of the latest ruling. The facilities to be looked at are the Anoka Metro Regional Treatment Center in Anoka and the Forensic Mental Health Program in St. Peter. An external reviewer will determine if use of restraints meets current best practices, with review to quantify the type, frequency and duration of mechanical restraints at each location. It also will specify whether positive supports were attempted prior to use of restraints. 

An initial report from the external reviewer is due March 13. A final report will be issued after the state responds. 

One huge concern at METO more than a decade ago was that patients were frequently subjected to “improper and inhumane use of seclusion and mechanical restraints,” according to court documents. Some METO patients were injured by used of physical restraints. Chemical restraints and seclusion of patients were also a focus in the original lawsuit. 

Currently at issue is the class action settlement agreement as it applies to prohibitive restraints and positive supports. The plaintiffs contend that the prohibition on such techniques extends to all state institutions, while state officials said that’s not the case. Also, the state sees such a prohibition as being a goal and not a mandate. 

One argument the state makes is that the prohibited techniques may apply to some facilities, but don’t apply to St. Peter and Anoka facilities. Some uses of mechanical restraints are needed to prevent injuries of patients as well as staff, even referring to use of restraints as best practices. 

The court finds that the language of the settlement agreement unambiguously limits prohibit techniques to some facilities, but not to Anoka and St. Peter. But the court calls for modernizing what are considered to be best practices. 

The ruling indicates that to determine whether the state’s use of mechanical restraints reflects current best practices, an external review is required. The review will give the state the opportunity to show that mechanical restraints are used in a limited and appropriate way, to prevent patients from injuring themselves and that such use complies with an advisory committee’s recommendations. 

A 2015 DHS letter to the court states that prone restraint is no longer allowed in any setting. The letter states that “great strides have been made in the area of restraint and seclusion since the Jensen settlement agreement was adopted by the court.” Restraint and seclusion is prohibited except for emergency use of manual restraint, in certain licensed settings when serving a person with a developmental disability and also in home and community-based settings when serving a person with a disability.  ■