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DEPARTMENT OF MENTAL HEALTH
NOTICE OF PROPOSED RULEMAKING
The Director of the Department of Mental Health (Department), pursuant to the authority set forth in sections 104, and 105 of the Department of Mental Health Establishment Amendment Act of 2001, effective December 18, 2001 (D.C. Law 14-56; D.C. Official Code §§ 7-1131.04 and 7-1131.05 (2008 Repl.)), hereby gives notice of the proposed rulemaking to amend chapter 5 (Use of Restraints and Seclusion) of subtitle A (Mental Health) of title 22 (Health) of the District of Columbia Municipal Regulations (DCMR).
The purpose of these amendments is to reflect changes in the use of legally mandated restraints at Saint Elizabeths Hospital which has moved from multiple facilities to a single facility, which includes the forensic program, maximum security units, and the civil program, consisting of minimum and moderate security units and a large courtyard. Therefore, it is no longer appropriate to restrict the use of legally mandated restraints to the transport of maximum security individuals to a non-maximum security facility. Rather, the changes reflect that legally mandated restraints are permissible in the transport of individuals outside of the maximum security area within a single facility or on the hospital grounds, which are continuing to be developed. Further, the amendment broadens the use of the term “legally mandated restraints” to include leather anklets and wristlets, rather than solely metal handcuffs and anklets to allow clinical staff a more physically comfortable option when ordering the use of restraints.
The Director gives notice of his intent to take final rulemaking action to adopt the proposed rules in not less than thirty (30) days from the date of publication of this notice in the D.C. Register.
Chapter 5 of subtitle A of title 22 of the DCMR is amended as follows:
Section 503 is amended to read as follows:
503 RESTRAINTS GENERALLY
503.1 Restraints shall include devices and techniques designed and used to control a consumer's behavior in an emergency.
503.2 Methods of restraint that may be prescribed in an emergency for consumers receiving services from an MH provider identified in § 500.7 of this chapter include:
(a) Four-point restraints;
(b) Five-point restraints;
(c) Physical holds;
(d) Legally mandated restraints;
(f) Medical restraints; and
(g) Drugs used as a restraint.
503.3 Four-point restraints are the use of soft bracelets encasing the wrists and ankles of a consumer lying on a bed (face up unless medically contraindicated), which are secured to the bed frame. Only restraint devices approved by the federal Food and Drug Administration for four-point restraints may be used.
503.4 Five-point restraints are a four-point restraint with the addition of a strap, which is placed over the consumer's upper torso and under the arms and secured to the bed frame.
503.5 A physical hold is the application of physical force by a staff person without the use of any mechanical device, for the purpose of restraining the free movement of a consumer's body. A physical hold does not include briefly holding a consumer without undue force in order to calm or comfort him or her, or holding a consumer's hand to safely escort him or her from one area to another.
503.6 Legally mandated restraints are the mechanical restraint of an adult maximum security consumer during transport from a facility, including a hospital, to District of Columbia Superior or Federal Court, or from a maximum security area of a facility to a non-maximum security area, or to an outside facility, applied in accordance with the order of a U.S. Marshal, a judge, or other law enforcement official or forensic services policy.
503.7 Medical restraints are the short-term use of physical restraint to facilitate completion of an emergency medical or surgical procedure. Medical restraint is limited to the duration of the emergency medical or surgical procedure.
503.8 A drug used as a restraint is a medication that is used to control extreme behavioral symptoms during an emergency. Drugs administered to a consumer on a regular basis as part of the consumer's regular prescribed medical regimen to treat mental, emotional, or behavioral disorders or to assist the consumer in gaining self-control in accordance with the consumer's service plan shall not constitute the use of a drug as a restraint, even if the purpose of the drug is to control ongoing behavior.
Section 513 is amended to read as follows:
513 LEGALLY MANDATED RESTRAINTS
513.1 This chapter does not govern the use of legally mandated restraints. Legally mandated restraints are restraints ordered by a court of law or restraints that are applied, monitored, and removed at the discretion of a law enforcement officer, such as a Deputy United States Marshal, an agent of the Secret Service, or an officer of the Metropolitan Police Department, with custody of a consumer, or restraints applied by hospital staff to a maximum security consumer when being transported from the maximum security area of the facility to a non-maximum security area of the facility, or outside the facility, in accordance with forensic services policy approved by the chief clinical officer of DMH.
513.2 Metal and leather handcuffs, wristlets, and anklets are prohibited, except with maximum security consumers who are secured by forensic services personnel in accordance with forensic services policy approved by the chief clinical officer of DMH, or the order of a judge, U.S. Marshall, or other law enforcement agency with appropriate jurisdiction for transport to:
(a) The District of Columbia Superior Court or Court of Appeals;
(b) Any Federal Court;
(c) Any non-maximum security area of the hospital, including areas on or outside the hospital grounds.
513.3 All procedures required for application of emergency restraint set forth in this chapter shall be followed unless specifically superseded by court order or the policy of the law enforcement agency with custody of the consumer.
All persons desiring to comment on the subject matter of this proposed rulemaking should file comments in writing not later than thirty (30) days after the date of publication of this notice in the D.C. Register. Comments should be filed with Deon Merene, Acting General Counsel, Office of General Counsel for the Department of Mental Health at 609 New York Avenue, N.E., 4th Floor, Washington, D.C. 20002, telephone (202) 673-1935, or Deon.Merene@dc.gov. Copies of the proposed rules may be obtained from www.dmh.dc.gov or from the Department of Mental Health at the address above.
