Section 22-A501. GENERAL PROVISIONS REGARDING THE USE OF RESTRAINT AND SECLUSION

 

501.1Each MH provider shall comply with the requirements of this chapter regarding the use of restraints and seclusion. Each MH provider shall have a policy addressing the use of restraint and seclusion that satisfies the requirements of §519.

 

501.2Restraints or seclusion shall only be used in an emergency in compliance with the following:

 

(a)The use of restraints or seclusion is, in the written opinion of the attending physician or physician assistant, necessary to prevent serious injury to the consumer or others;

 

(b)Less restrictive treatment techniques have been tried or considered and determined to be ineffective to prevent serious injury to the consumer or others; and

 

(c)The attending physician or physician assistant gives a written order, within one (1) hour of the initiation of either restraints or seclusion, for the use of restraints or seclusion. If the consumer's treating physician is available in person at the time the emergency arises, he or she is deemed to be the attending physician for purposes of this chapter.

 

501.3Any use of restraints or seclusion with a consumer shall be:

 

(a)Implemented in the least restrictive manner possible;

 

(b)Implemented in accordance with safe and appropriate techniques, which include:

 

(1)The application of restraints or placement in seclusion by trained and educated MH provider staff in a manner that is designed to prevent serious harm to the consumer or others;

 

(2)The application of restraints or placement in seclusion that is appropriate for the severity of the consumer's condition or behavior, as well as the consumer's chronological and developmental age, size, gender, physical, mental, and emotional condition, and personal history, including any history of trauma, physical, sexual or mental abuse; and

 

(3)The application of restraints or placement in seclusion such that it is assured that the consumer is allowed to maintain normal bodily processes, breathing patterns, and blood circulation during the entire time the restraint is employed.

 

(c)Continually assessed, monitored, and evaluated; and

 

(d)Ended at the earliest possible time.

 

501.4All restraints shall be sanitized after each use.

 

501.5The health and safety of the consumer are of paramount importance at all times. If a consumer demonstrates a need for medical attention in the course of an episode of restraints or seclusion, medical priorities shall supersede behavioral priorities, the use of restraints or seclusions shall be terminated immediately, and the consumer shall receive immediate medical attention.

 

501.6Restraints and seclusion are not treatment modalities. Neither the use of restraints nor the placement of a consumer in seclusion shall be included as a mental health support or mental health service in a consumer's service plan. However, a service plan may address the need for a reduction or elimination of the use of restraints or seclusion in an emergency, through the use of alternative behavior management techniques or other less restrictive interventions.

 

501.7Restraints or seclusion shall never:

 

(a)Be used as a means of coercion, discipline, convenience, or retaliation;

 

(b)Be used in any manner that obstructs the airways or impairs breathing;

 

(c)Take the form of pepper spray, mace, handcuffs, or electronic devices, such as stun guns; or

 

(d)Be used simultaneously with another method of restraint, unless otherwise permitted by this chapter.

 

501.8An order for restraints or seclusion shall never be written in a non-emergency situation, as a standing order, or on an as-needed basis.

 

501.9Restraints shall only be used in a manner consistent with the manufacturer's instructions for care and use of the devices.

 

501.10The effects of and any conditions, symptoms or injuries resulting from any restraint or seclusion used with a consumer shall be documented in the consumer's clinical record.

 

501.11Specific policies and procedures for employing each method of restraint and seclusion are set forth in this chapter. Any use of a restraint or seclusion on a consumer by a MH provider's staff that is not in accordance with this chapter shall constitute a violation of this chapter, and may constitute a violation of other District or federal laws or regulations.

 

authority

Sections 114 and 209 of the Mental Health Service Delivery Reform Act of 2001, effective December 18, 2001 (D.C. Law 14-56; D.C. Official Code §§ 7-1131.14 and 1231.09 (2001 ed.)).

source

Emergency and Proposed Rulemaking published at 51 DCR 8691 (September 3, 2004)[EXPIRED]; as amended by Emergency and Proposed Rulemaking published at 51 DCR 11863 (December 31, 2004)[EXPIRED]; as amended by Emergency and Proposed Rulemaking published at 52 DCR 5957 (June 24, 2005)[EXPIRED]; as amended by Final Rulemaking published at 52 DCR 7229 (August 5, 2005).