XPost: alt.government.abuse, alt.society.civil-liberties, alt   
   From: remailer@frogadmin.yi.org   
      
   Mental patients isolated for years despite laws   
      
   By DENA POTTER, Associated Press Writer   
   Tue Dec 23, 2:01 pm ET   
      
   STAUNTON, Va. Ð Mental patients sprinkled throughout the nation's psychiatric   
   hospitals are being locked up alone for years despite laws aimed at preventing   
   the practice, because medical workers say they're too dangerous to handle any   
   other way.   
      
   Health officials call them outliers Ñ rare, unpredictably violent people who   
   don't respond to medication or other treatment. Advocates call them victims of   
   a system that has lost patience and creativity in caring for those who are   
   most difficult to treat.   
      
   Loopholes in federal and state laws and impotent oversight allow hospitals to   
   lock some patients away for the safety of staff and other patients. Some cases   
   involving seclusion and restraints have resulted in costly lawsuits, yet they   
   are so rare that    
   many advocates had no idea there were similar situations in other states until   
   The Associated Press inquired about it.   
   No one tracks such cases. However, through interviews and records from   
   advocacy groups and state and federal agencies, the AP found at least a dozen   
   patients who were held in seclusion for months or years at a time.   
   "I think it's just a wink and a nod and some people are looking the other   
   way," said Charlie McCarthy, an advocate with Disability Rights Montana, who   
   nevertheless said he understands what drives hospitals to work around the law.   
      
   "Everybody's frustrated with what do you do with somebody like this? The   
   patient has rights, but the other patients have rights to be safe and free   
   from abuse."   
      
   In Virginia, one man was locked in a three-room suite for 15 years and another   
   patient was held in a similar setup for five years. Connecticut and Florida   
   have paid millions over allegations that they tethered patients to furniture   
   for years.   
      
   Federal law requires that seclusion or restraints Ñ including drugs Ñ be used   
   on patients covered by Medicare or Medicaid only in emergencies to protect   
   other patients and staff. Such measures can be used for more than 24 hours   
   only if a physician deems    
   it necessary, and only if a doctor updates that assessment daily.   
      
   Moreover, the U.S. Supreme Court has ruled it unconstitutional to restrain or   
   isolate patients for extended periods.   
      
   The laws and court rulings don't cap the consecutive days a patient can be   
   isolated or restrained, though, so hospitals can hold a patient indefinitely   
   by simply signing off on it every 24 hours.   
      
   The Supreme Court also has ruled that hospitals must treat people who are   
   involuntarily committed. So Stuart Grassian, a psychiatrist who has studied   
   the effects of solitary confinement on prisoners, and others question whether   
   outliers are being held    
   legally.   
      
   "Once a person is locked up, the state has to provide them with adequate and   
   appropriate treatment, otherwise they lose any authority and any legitimacy to   
   keeping the people locked up against their will," Grassian said.   
      
   Seclusion, he said, can intensify patients' paranoia, agitation and delusions.   
      
   Advocates insist that with proper training and sufficient staffing, hospitals   
   can eliminate the need for seclusion and restraints in nearly all cases, not   
   just outliers.   
      
   In 1997, Pennsylvania enacted stricter policies against those techniques,   
   trained staff in crisis management and established minimum staffing levels for   
   its psychiatric facilities. Today, the state does not seclude or restrain   
   patients for extended    
   periods and rarely uses either method at all, according to the state mental   
   health agency.   
      
   Such efforts can be costly, but proponents cite them as proof that with the   
   right support, any mentally ill person can improve enough to safely interact   
   with others.   
      
   "People can make progress and they do get to a point where they can be   
   reintegrated into the community," said Deborah Dorfman, deputy director of the   
   Los Angeles-based Disability Rights Legal Center. "You just need the right   
   treatment and the right    
   expertise."   
      
   A spokesman for the Justice Department's Civil Rights Division, which   
   investigates complaints concerning institutionalized individuals, would not   
   comment on the use of seclusion and restraint. According to its Web site, the   
   division wrapped up two probes    
   this year that found improper use of seclusion and restraint in Oregon and   
   Georgia and recommended policy changes to the governors of those states.   
      
   At Oregon State Hospital, investigators found four patients who had lived in   
   prolonged seclusion, some for at least a year. In a report, the Justice   
   Department called the practice "unrefined and unlawful" and said it had never   
   "encountered the use of    
   continuous seclusion as a planned treatment strategy."   
      
   Since 2006, the Justice Department has entered into settlements with   
   California, Vermont and the District of Columbia over violations that include   
   improper seclusion and restraint at mental hospitals.   
      
   At Western State Hospital in Staunton, Va., the state stepped in after staff   
   placed Cesar Chumil in a three-room "limited containment suite" in 1993, where   
   he has remained since. Chumil averaged 300 assaults against staff and another   
   100 against patients    
   over seven years before he was placed in the suite, according to records from   
   a closed administrative hearing obtained by the AP.   
      
   Hospital officials claim the 58-year-old has more freedom than before, when   
   records show he spent thousands of hours in a small seclusion cell or   
   restrained to a bed or chair.   
      
   "It's a big step to put somebody in a room like this and say, 'You can't come   
   out,' but we had so many people getting injured and so many staff were out of   
   work," said Stephen Johnson, the psychologist on Chumil's ward. "It just got   
   to the point where it    
   was just untenable ... so we had this one solution."   
      
   Last summer, a state oversight committee determined that the hospital should   
   move Chumil out of seclusion. The hospital moved all other patients off   
   Chumil's ward this month and unlocked the door to his suite so he could go out   
   into an activity room when    
   he wanted. Hospital workers in padded gear and helmets must be present Ñ for   
   everyone's safety, but also so that he is no longer alone and therefore no   
   longer technically in seclusion.   
   In Connecticut, a 23-year-old man has lived in a two-room cell since 2001,   
   said Nancy Alisberg, an attorney for the state's Office of Protection and   
   Advocacy. When he behaves, staff take him on walks around the grounds and   
   sometimes take him to church    
   and other places, she said, declining to identify the man because of privacy   
   laws.   
      
      
   [continued in next message]   
      
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